Provider Demographics
NPI:1073232609
Name:VICTORY COMMUNITY PHARMACY INC
Entity Type:Organization
Organization Name:VICTORY COMMUNITY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PANOSYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:818-859-7040
Mailing Address - Street 1:101 N VICTORY BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1847
Mailing Address - Country:US
Mailing Address - Phone:818-859-7040
Mailing Address - Fax:818-859-7042
Practice Address - Street 1:101 N VICTORY BLVD STE C
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1847
Practice Address - Country:US
Practice Address - Phone:818-859-7040
Practice Address - Fax:818-859-7042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-25
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY58742OtherBOARD OF PHARMACY