Healthcare Provider Details

I. General information

NPI: 1295741841
Provider Name (Legal Business Name): VICTORY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 92ND ST
BROOKLYN NY
11228-3619
US

IV. Provider business mailing address

699 92ND ST
BROOKLYN NY
11228-3619
US

V. Phone/Fax

Practice location:
  • Phone: 718-567-1203
  • Fax: 718-567-1438
Mailing address:
  • Phone: 718-567-1203
  • Fax: 718-567-1438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number009868
License Number StateNY

VIII. Authorized Official

Name: RICHARD WILLIAMS
Title or Position: DIRECTOR OF PHARMACY
Credential: MS PHARMD
Phone: 718-567-1203