Provider Demographics
NPI:1447662648
Name:VICTOR, JANIS LYNNE (RPH)
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:LYNNE
Last Name:VICTOR
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 RIVERSIDE DR
Mailing Address - Street 2:WALMART PHARMACY
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344
Mailing Address - Country:US
Mailing Address - Phone:928-669-8306
Mailing Address - Fax:928-669-8357
Practice Address - Street 1:100 RIVERSIDE DR
Practice Address - Street 2:WALMART PHARMACY
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344
Practice Address - Country:US
Practice Address - Phone:928-669-8306
Practice Address - Fax:928-669-8357
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS020425183500000X
NV18018183500000X
MI5302023547183500000X
FLPS32405183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist