MEDICARE: DR. MAGDALINE VICTORIN PHARM.D.

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	50549	FL
2	183500000X	Pharmacist	24975	NC
3	183500000X	Pharmacist	7580	FL

General Provider Information

NPI Number	:	1386020584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAGDALINE VICTORIN PHARM.D.

Provider Business Mailing Address
First Line	:	3515 DAVID COX RD
Second Line	:	UNIT 480902
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-2571
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6319 WATERFORD HILLS DR
Second Line	:	APT 1312
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-3139
Country	:	US
Telephone Number	:	980-320-0517
Fax Number	:

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

Provider Enumeration Date	:	08/11/2015
Last Update Date	:	08/11/2015

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