Provider Demographics
NPI:1063749109
Name:CHACKO, RAKESH
Entity type:Individual
Prefix:
First Name:RAKESH
Middle Name:
Last Name:CHACKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 N BELT LINE RD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-4016
Mailing Address - Country:US
Mailing Address - Phone:469-417-0358
Mailing Address - Fax:469-417-0236
Practice Address - Street 1:1330 N BELT LINE RD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-4016
Practice Address - Country:US
Practice Address - Phone:469-417-0358
Practice Address - Fax:469-417-0236
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43651183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist