Healthcare Provider Details

I. General information

NPI: 1841124005
Provider Name (Legal Business Name): VICTORIA SAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 MAIN ST
WARRINGTON PA
18976-2492
US

IV. Provider business mailing address

1859 GREYMONT ST
PHILADELPHIA PA
19116-3829
US

V. Phone/Fax

Practice location:
  • Phone: 215-918-3940
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP460264
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: