Healthcare Provider Details

I. General information

NPI: 1982185138
Provider Name (Legal Business Name): VICTUS HEALTH AND WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2018
Last Update Date: 08/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 NUTT RD STE D
PHOENIXVILLE PA
19460-3905
US

IV. Provider business mailing address

165 NUTT RD STE D
PHOENIXVILLE PA
19460-3905
US

V. Phone/Fax

Practice location:
  • Phone: 610-933-2609
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS KATRA
Title or Position: PHARMACIST
Credential: PHARMD
Phone: 610-933-2609