Provider Demographics
NPI:1366751752
Name:VICTORY PHARMACY CORPORATION
Entity type:Organization
Organization Name:VICTORY PHARMACY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HILARY
Authorized Official - Middle Name:JACK
Authorized Official - Last Name:MBADUGHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-625-0387
Mailing Address - Street 1:11328 TARA BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-6229
Mailing Address - Country:US
Mailing Address - Phone:678-519-3376
Mailing Address - Fax:678-519-3404
Practice Address - Street 1:11328 TARA BLVD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-6229
Practice Address - Country:US
Practice Address - Phone:678-519-3376
Practice Address - Fax:678-519-3404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0096843336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy