Provider Demographics
NPI:1285943829
Name:VICTORY PHARMACY
Entity type:Organization
Organization Name:VICTORY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WOLE
Authorized Official - Middle Name:K
Authorized Official - Last Name:ADEOYE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:217-428-4000
Mailing Address - Street 1:163 N WATER ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62523-1309
Mailing Address - Country:US
Mailing Address - Phone:217-428-4000
Mailing Address - Fax:217-429-8651
Practice Address - Street 1:2280 E WILLIAM ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-1528
Practice Address - Country:US
Practice Address - Phone:217-422-1000
Practice Address - Fax:217-422-2658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy