Provider Demographics
NPI:1720968670
Name:CHACKO, MANOJ (BS)
Entity type:Individual
Prefix:
First Name:MANOJ
Middle Name:
Last Name:CHACKO
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 N WESTMORELAND RD STE 314
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-2444
Mailing Address - Country:US
Mailing Address - Phone:214-339-2352
Mailing Address - Fax:214-330-2324
Practice Address - Street 1:1050 N WESTMORELAND RD STE 314
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-2444
Practice Address - Country:US
Practice Address - Phone:214-339-2352
Practice Address - Fax:214-330-2324
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38741183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist