Healthcare Provider Details

I. General information

NPI: 1174512537
Provider Name (Legal Business Name): VICTORIA PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 S HOSMER ST SUITE C
TACOMA WA
98408-1017
US

IV. Provider business mailing address

PO BOX 9299
TACOMA WA
98490-0299
US

V. Phone/Fax

Practice location:
  • Phone: 253-302-4178
  • Fax: 253-503-0858
Mailing address:
  • Phone: 253-302-4178
  • Fax: 253-503-0858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberCF00002783
License Number StateWA

VIII. Authorized Official

Name: AMY POND
Title or Position: PRESIDENT
Credential: RPH
Phone: 253-473-1919