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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