Organization
LIVEWELL INC
Active
Other names
Cannon Pharmacy-Concord
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN FREEMAN (PRESIDENT)
(704) 933-6337
Entity
Organization
Contact information
Practice address
760 CABARRUS AVE W, W, CONCORD, NC 28027-6851
(704) 788-6337
(704) 933-6338
Mailing address
760 CABARRUS AVE W, CONCORD, NC 28027-6851
(704) 788-6337
(704) 933-6338
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
10595
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2126626
PK
—
Enumeration date
09/30/2010
Last updated
12/19/2013
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