Organization
PANTHER HEALTH LLC
Active
Other names
Cannon Pharmacy Mooresville
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN YANICKO PHARMD (MANAGER/PHARMACIST)
(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
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
12647
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1225412562
—
NC
01
—
2153237
PK
—
Enumeration date
07/16/2015
Last updated
11/02/2022
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