Active NPI
Panackal O John
- Pharmacist
- Gainsville, GA
National Provider Identifier
1295019495
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- RPH021035
- Practice address
- 472 S Enota Dr
Gainsville, GA 30501 - Phone
- (770) 535-3750
- Fax
- (770) 535-4071
- NPI assigned
- Oct 6, 2011
- Sex
- Male
- Sole proprietor
- No
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH021035 | GA | MD | Pharmacist |
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH021035 | GA | Primary |
Addresses
Primary practice location
472 S Enota Dr
Gainsville, GA 30501
Mailing address
2304 Malden Park Dr
Buford, GA 30519
Phone (678) 985-2712
NPI Registry JSON
{
"created_epoch": "1317859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317859200000",
"number": "1295019495",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2304 MALDEN PARK DR",
"city": "BUFORD",
"state": "GA",
"postal_code": "30519",
"telephone_number": "678-985-2712"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "472 S ENOTA DR",
"city": "GAINSVILLE",
"state": "GA",
"postal_code": "30501",
"telephone_number": "770-535-3750",
"fax_number": "770-535-4071"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHN",
"first_name": "PANACKAL",
"middle_name": "O",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-10-06",
"last_updated": "2011-10-06",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "RPH021035",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gainsville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.