Provider Information for 1073621454
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VICTORY DISTRIBUTORS LLC
Other Names:Doing Business As:HANNAFORD SUPERMARKET & PHARMACYOrganization Subpart: NO
NPI: 1073621454
Last Updated: 2018-07-19
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Details
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NPI | 1073621454 | ||||||||||||
Enumeration Date | 2006-08-27 | ||||||||||||
NPI Type | NPI-2 Organization | ||||||||||||
Status | Active | ||||||||||||
Authorized Official Information | Name: MICHAEL VAIL Title: President and Manager Phone: 2078857454 | ||||||||||||
Mailing Address | PO BOX 1000 MS 3000 PORTLAND, ME 04104-5005 United States Phone: 207-885-7454 | Fax:704-645-6531 | ||||||||||||
Primary Practice Address | 5 GILBERT ST N BROOKFIELD, MA 01535-1409 United States Phone: 508-867-4891 | Fax:508-867-4896 | ||||||||||||
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