Provider Demographics
NPI:1740879097
Name:VIC'S FAMILY PHARMACY INC
Entity type:Organization
Organization Name:VIC'S FAMILY PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:F
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:208-465-7000
Mailing Address - Street 1:119 S VALLEY DR STE A
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-2985
Mailing Address - Country:US
Mailing Address - Phone:208-465-7000
Mailing Address - Fax:
Practice Address - Street 1:118 S MIDLAND BLVD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-2601
Practice Address - Country:US
Practice Address - Phone:208-442-1000
Practice Address - Fax:208-442-1091
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIC'S FAMILY PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-12
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy