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General NPI Number Information
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NPI Number | 1356913479
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Entity Type | Organization
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Legal Business Name | PANACEA COMPOUNDING PHARMACY PLLC
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Dates
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Enumeration Date | 07/16/2021
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Last Update Date | 06/02/2022
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Provider Practice Location Address
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Address Line | 28573 NORTHWESTERN HWY
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City | SOUTHFIELD
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State | MI
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Zip | 48034-1824
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Country | US
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Telephone | 248-841-4325
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Fax |
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Provider Business Mailing Address
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Address Line | 519 MERIDAN ST
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City | DEARBORN
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State | MI
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Zip | 48124-1357
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Country | US
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Telephone | 313-995-2595
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANNY ANOUTI
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Credential |
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Telephone | 313-995-2595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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