Organization
VICTAPHARM
Active
Parent organization
VICTA LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
VICTA LLC
Authorized official
LISA A PETERSON (CHIEF OPERATING OFFICER)
(401) 432-6029
Entity
Organization
Contact information
Practice address
110 ELMWOOD AVE, PROVIDENCE, RI 02907-2423
(401) 300-5757
Mailing address
110 ELMWOOD AVE, PROVIDENCE, RI 02907-2423
(401) 300-5757
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104317007
—
RI
Enumeration date
12/08/2021
Last updated
12/08/2021
About Stedi
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