Provider Demographics
NPI:1619580545
Name:VICTORY PHARMACY OF DECATUR INC
Entity Type:Organization
Organization Name:VICTORY PHARMACY OF DECATUR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLUWOLE
Authorized Official - Middle Name:K
Authorized Official - Last Name:ADEOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-801-9626
Mailing Address - Street 1:1837 RIVER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-5071
Mailing Address - Country:US
Mailing Address - Phone:708-801-9626
Mailing Address - Fax:708-801-9132
Practice Address - Street 1:2024 W 79TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-5720
Practice Address - Country:US
Practice Address - Phone:773-994-2845
Practice Address - Fax:773-482-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-29
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy