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General NPI Number Information
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NPI Number | 1447523584
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Entity Type | Organization
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Legal Business Name | PANACEA PHARMACY LLC
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Dates
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Enumeration Date | 02/21/2012
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Last Update Date | 05/14/2012
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Provider Practice Location Address
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Address Line | 1050 N WESTMORELAND RD STE 314
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City | DALLAS
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State | TX
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Zip | 75211-2444
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Country | US
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Telephone | 214-339-2352
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Fax | 214-330-2624
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Provider Business Mailing Address
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Address Line | 1050 N WESTMORELAND RD SUITE 314
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City | DALLAS
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State | TX
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Zip | 75211-2444
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Country | US
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Telephone | 214-339-2352
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Fax | 214-330-2624
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Authorized Official
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Title or Position | OWNER
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Name | MANOJ CHACKO
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Credential |
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Telephone | 972-369-5589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 27904
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License Number State | TX
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