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Organization
VICTORY RX LLC
Active
Organization
VICTORY RX LLC
Active
Other names
RANDALL MANOR PHARMACY & SURGICALS
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLAS AMAXAS RPH (PHARMACIST/OWNER)
(718) 720-2324
Entity
Organization
Contact information
Practice address
395 FOREST AVE, STATEN ISLAND, NY 10301-2622
(718) 720-2324
(718) 720-2327
Mailing address
395 FOREST AVE, STATEN ISLAND, NY 10301-2622
(718) 720-2324
(718) 720-2327
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
030142
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2125564
PK
—
05
—
3249612
—
NY
Enumeration date
03/16/2010
Last updated
11/03/2014
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