Organization
VICTORY DISTRIBUTORS, LLC
Active
Other names
Hannaford Food & Drug #8164
Organization subpart
No
Provider details
NPI number
Authorized official
ELWEN EATON (PHARMACY INSURANCE SPECIALIST)
(207) 885-7454
Entity
Organization
Contact information
Practice address
201 JOHN DEVINE DR, MANCHESTER, NH 03103-4034
(603) 626-1233
(603) 626-3002
Mailing address
PO BOX 1000, MS3000, PORTLAND, ME 04104-5005
(207) 885-7454
(207) 885-3121
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0366-P
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3004809
NCPDP PROVIDER NUMBER
—
05
—
30707665
—
NH
Enumeration date
08/24/2009
Last updated
11/18/2014
Update your record
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