Provider Demographics
NPI:1497828065
Name:PANACEA INC
Entity Type:Organization
Organization Name:PANACEA INC
Other - Org Name:MEDICAL ARTS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MUHIZI
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:305-247-4488
Mailing Address - Street 1:944 N KROME AVENUE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030
Mailing Address - Country:US
Mailing Address - Phone:305-247-4488
Mailing Address - Fax:305-248-8375
Practice Address - Street 1:944 N KROEM AVENUE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030
Practice Address - Country:US
Practice Address - Phone:305-247-4488
Practice Address - Fax:305-248-8375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH471332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104850300Medicaid
FLPH471OtherSTATE LICENSE
AP1560259OtherDEA