Organization
LIVEWELL INC
Active
Other names
Cannon Pharmacy of Mooresville
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN FREEMAN (PRESIDENT)
(704) 933-6337
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
3336C0003X
Community/Retail Pharmacy
Primary
10205
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3413274
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
01/13/2009
Last updated
01/23/2013
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