MEDICARE: VICTORIA SAM

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	RP460264	PA

General Provider Information

NPI Number	:	1841124005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA SAM

Provider Business Mailing Address
First Line	:	1859 GREYMONT ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19116-3829
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1405 MAIN ST
Second Line	:
City	:	WARRINGTON
State	:	PA
Zip	:	18976-2492
Country	:	US
Telephone Number	:	215-918-3940
Fax Number	:

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

Provider Enumeration Date	:	06/11/2026
Last Update Date	:	06/11/2026

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Directions to “ VICTORIA SAM ” Practice Location

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