Healthcare Provider Details

I. General information

NPI: 1619326998
Provider Name (Legal Business Name): VICTORIA DRUG COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 MAIN ST
VICTORIA VA
23974-9204
US

IV. Provider business mailing address

1821 MAIN ST P.O. BOX 1431
VICTORIA VA
23974-9204
US

V. Phone/Fax

Practice location:
  • Phone: 434-696-3343
  • Fax: 434-696-2418
Mailing address:
  • Phone: 434-696-3343
  • Fax: 434-696-2418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0201000837
License Number StateVA

VIII. Authorized Official

Name: MS. DIANE ASHWORTH
Title or Position: CO-OWNER
Credential:
Phone: 434-696-3343