Organization
VICTORY DISTRIBUTORS LLC
Active
Other names
Hannaford Supermarket & Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ELWEN EATON (PHARMACY INSURANCE SPECIALIST)
(207) 885-7454
Entity
Organization
Contact information
Practice address
25 ROBERT DR, SOUTH EASTON, MA 02375-1356
(508) 238-4067
(508) 238-6153
Mailing address
PO BOX 1000, PORTLAND, ME 04104-5005
(207) 885-7454
(207) 885-3121
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
89691
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0497771
—
MA
01
—
2039560
PK
—
Enumeration date
08/27/2006
Last updated
07/29/2016
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