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Organization
PANTHER HEALTH, LLC
Active
Organization
PANTHER HEALTH, LLC
Active
Other names
Cannon Pharmacy Mooresville DME
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RYAN YANICKO PHARMD (PHARMACIST OWNER)
(704) 658-9870
Entity
Organization
Contact information
Practice address
521 E PLAZA DR, MOORESVILLE, NC 28115-8071
(704) 658-9870
(704) 658-9871
Mailing address
521 E PLAZA DR, MOORESVILLE, NC 28115-8071
(704) 658-9870
(704) 658-9871
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
1225412562
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1225412562
—
NC
Enumeration date
07/22/2016
Last updated
11/02/2022
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