Provider Demographics
NPI:1528413945
Name:VICTORY RX, INC
Entity Type:Organization
Organization Name:VICTORY RX, INC
Other - Org Name:LOCAL HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP RDO
Authorized Official - Prefix:DR
Authorized Official - First Name:SELMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DZELIL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:815-715-8502
Mailing Address - Street 1:2545 W. DIVERSEY AVE STE. 104
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647
Mailing Address - Country:US
Mailing Address - Phone:773-673-5493
Mailing Address - Fax:844-224-0287
Practice Address - Street 1:2545 W. DIVERSEY AVE STE. 104
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647
Practice Address - Country:US
Practice Address - Phone:773-673-5493
Practice Address - Fax:844-224-0287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-04
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
IL054.0206353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159908OtherPK
2159908OtherPK