MEDICARE: VICS FAMILY PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	800CP	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1304790	OTHER		NABP
2	800CP	OTHER	ID	BOARD OF PHARMACY
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255329405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICS FAMILY PHARMACY INC

Provider Business Mailing Address
First Line	:	1513 12TH AVE RD
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-6008
Country	:	US
Telephone Number	:	208-465-7000
Fax Number	:	208-465-7091

Provider Business Practice Location Address
First Line	:	1513 12TH AVE RD
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-6008
Country	:	US
Telephone Number	:	208-465-7000
Fax Number	:	208-465-7091

Authorized Official
Title or Position	:	OWNER PHARMACIST IN CHARGE
Name	:	MR. VICTOR F ALLEN
Credential	:	BPH
Telephone Number	:	208-465-7000

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	01/15/2019

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Directions to “VICS FAMILY PHARMACY INC ” Practice Location

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