MEDICARE: VICTORIA CHARLOTTE VANCE PHARMD

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	183500000X	Pharmacist	RP457962	PA

General Provider Information

NPI Number	:	1306618012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA CHARLOTTE VANCE PHARMD

Provider Business Mailing Address
First Line	:	518 PORT ROYAL AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-2144
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	518 PORT ROYAL AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-2144
Country	:	US
Telephone Number	:	215-483-6680
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2023
Last Update Date	:	10/25/2023

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