Organization
LIVEWELL INC
Active
Other names
Cannon Pharmacy Morrocroft
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTEN DINAN RPH (PHARMACIST MANAGER OWNER)
(704) 367-7440
Entity
Organization
Contact information
Practice address
4501 CAMERON VALLEY PKWY STE 125, CHARLOTTE, NC 28211-4299
(704) 367-7440
(704) 365-2345
Mailing address
4501 CAMERON VALLEY PKWY STE 125, SUITE 125, CHARLOTTE, NC 28211-4299
(704) 367-7440
(704) 365-2345
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
7883
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0609491
—
NC
01
—
3427196
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/20/2006
Last updated
01/23/2013
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