Organization
LIVEWELL, INC. DBA CANNON PHARMACY COMPOUNDING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATT MILLER PHARMD (CO-OWNER)
(704) 658-9870
Entity
Organization
Contact information
Practice address
563 JACKSON PARK RD, KANNAPOLIS, NC 28083-3657
(704) 932-5050
(704) 933-7758
Mailing address
563 JACKSON PARK RD, KANNAPOLIS, NC 28083-3657
(704) 932-5050
(704) 933-7758
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
11070
NC
Other
Enumeration date
09/29/2011
Last updated
09/29/2011
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