=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801183595
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VICTORY DAY PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2011
-----------------------------------------------------
Last Update Date | 08/23/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 43 E BROAD ST
-----------------------------------------------------
City | PAULSBORO
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08066-1451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-224-9800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 43 E BROAD ST
-----------------------------------------------------
City | PAULSBORO
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08066-1451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-224-9800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST IN CHARGE
-----------------------------------------------------
Name | ADAKU AJOKU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 267-918-9950
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 28RS00713000
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------