Organization
LIVEWELL INC
Active
Other names
Cannon Pharmacy-Sedgefield
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN FREEMAN (PRESIDENT PIC)
(704) 933-6337
Entity
Organization
Contact information
Practice address
2334 SOUTH BLVD, CHARLOTTE, NC 28203-5008
(704) 523-8608
(704) 523-8619
Mailing address
2334 SOUTH BLVD, CHARLOTTE, NC 28203-5008
(704) 523-8608
(704) 523-8619
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
10527
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3401863
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
02/07/2007
Last updated
01/23/2013
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