Provider Demographics
NPI:1053456087
Name:VICTORIA DRUG COMPANY
Entity Type:Organization
Organization Name:VICTORIA DRUG COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-696-3343
Mailing Address - Street 1:1821 MAIN STREET
Mailing Address - Street 2:P.O. BOX AG
Mailing Address - City:VICTORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23974
Mailing Address - Country:US
Mailing Address - Phone:434-696-3343
Mailing Address - Fax:434-696-2418
Practice Address - Street 1:1821 MAIN STREET
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:VA
Practice Address - Zip Code:23974
Practice Address - Country:US
Practice Address - Phone:434-696-3343
Practice Address - Fax:434-696-2418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02010008373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy