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NPI Code Detail

MEDICARE: VICTORY PHARMACY

MEDICARE: VICTORY PHARMACY
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
1183500000XPharmacistPH02108NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12989347OTHERNVNCPDP

General Provider Information

NPI Number : 1780620658
Entity Type Code : Organization
Provider Name (Legal Business Name) : VICTORY PHARMACY
Provider Business Mailing Address
First Line : 4161 S EASTERN AVE
Second Line : A3
City : LAS VEGAS
State : NV
Zip : 89119-5484
Country : US
Telephone Number : 702-893-9361
Fax Number : 702-893-9364
Provider Business Practice Location Address
First Line : 4161 S EASTERN AVE
Second Line : A3
City : LAS VEGAS
State : NV
Zip : 89119-5484
Country : US
Telephone Number : 702-893-9361
Fax Number : 702-893-9364
Authorized Official
Title or Position : OWNER
Name : DR. VICOTR BERAJA
Credential : RPH
Telephone Number : 702-893-9361
Provider Enumeration Date : 06/21/2006
Last Update Date : 04/17/2008

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Directions to “VICTORY PHARMACY ” Practice Location

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