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General NPI Number Information
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NPI Number | 1285944975
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Entity Type | Organization
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Legal Business Name | PANACEA PHARMACY AND WELLNESS CENTER INC
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Dates
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Enumeration Date | 10/14/2010
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Last Update Date | 10/14/2010
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Provider Practice Location Address
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Address Line | 225 PEACHTREE ST NE SUITE B13
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City | ATLANTA
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State | GA
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Zip | 30303-1701
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Country | US
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Telephone | 404-602-0024
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Fax | 404-602-0017
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Provider Business Mailing Address
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Address Line | 225 PEACHTREE ST NE SUITE B13
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City | ATLANTA
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State | GA
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Zip | 30303-1701
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Country | US
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Telephone | 404-602-0024
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Fax | 404-602-0017
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Authorized Official
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Title or Position | PRESIDENT
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Name | NOUR ISSA
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Credential | RPH
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Telephone | 404-602-0024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHRE009701
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License Number State | GA
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