Organization
PANACEA PHARMACY LLC
Active
Other names
PANACEA RX PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MANOJ CHACKO (OWNER)
(972) 369-5589
Entity
Organization
Contact information
Practice address
1050 N WESTMORELAND RD STE 314, DALLAS, TX 75211-2444
(214) 339-2352
(214) 330-2624
Mailing address
1050 N WESTMORELAND RD, SUITE 314, DALLAS, TX 75211-2444
(214) 339-2352
(214) 330-2624
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
27904
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0146549
—
TX
01
—
5905217
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/21/2012
Last updated
05/14/2012
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