Provider Demographics
NPI:1508532607
Name:CHILDS, VICTORIA
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:CHILDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2485 AVENUE I
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:KS
Mailing Address - Zip Code:67457-9113
Mailing Address - Country:US
Mailing Address - Phone:970-629-0970
Mailing Address - Fax:
Practice Address - Street 1:821 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HOISINGTON
Practice Address - State:KS
Practice Address - Zip Code:67544-1842
Practice Address - Country:US
Practice Address - Phone:620-653-2200
Practice Address - Fax:620-653-7359
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-106226183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist