Organization
LIVEWELL INC
Active
Other names
CANNON PHARMACY EBENEZER RD
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN FREEMAN (PRESIDENT)
(704) 965-0039
Entity
Organization
Contact information
Practice address
1402 N CANNON BLVD, KANNAPOLIS, NC 28083-2662
(704) 933-7948
(704) 933-7958
Mailing address
1402 N CANNON BLVD, KANNAPOLIS, NC 28083-2662
(704) 933-7948
(704) 933-7958
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
09998
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2067185
PK
—
Enumeration date
02/22/2008
Last updated
10/03/2013
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