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	3336L0003X	Long Term Care Pharmacy
2	333600000X	Pharmacy	16667RP	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2130713	OTHER		PK

General Provider Information

NPI Number	:	1861780330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICS FAMILY PHARMACY INC

Provider Business Mailing Address
First Line	:	119 S VALLEY DR
Second Line	:	SUITE A # 120
City	:	NAMPA
State	:	ID
Zip	:	83686-2974
Country	:	US
Telephone Number	:	208-465-7000
Fax Number	:	208-465-7091

Provider Business Practice Location Address
First Line	:	118 S MIDLAND BLVD
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-2601
Country	:	US
Telephone Number	:	208-442-1000
Fax Number	:	208-442-1091

Authorized Official
Title or Position	:	OWNER
Name	:	VICTOR ALLEN
Credential	:
Telephone Number	:	208-465-7000

Provider Enumeration Date	:	07/18/2011
Last Update Date	:	02/13/2019

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Directions to “VICS FAMILY PHARMACY INC ” Practice Location

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