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Organization

LIVEWELL INC

Active
Other names
CANNON PHARMACY
Organization subpart
No

Provider details

NPI number
Authorized official
BRIAN FREEMAN (PRESIDENT PIC)
(704) 933-6337
Entity
Organization

Contact information

Practice address
1706 S CANNON BLVD, KANNAPOLIS, NC 28083-6104
(704) 933-6337
(704) 933-6374
Mailing address
1706 S CANNON BLVD, KANNAPOLIS, NC 28083-6104
(704) 933-6337
(704) 933-6374

Taxonomy

Speciality
Code
Description
License number
State
333600000X
Pharmacy
3336C0003X
Community/Retail Pharmacy
Primary
08881
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0135919
NC
01
2067567
PK
Enumeration date
09/20/2006
Last updated
12/23/2013
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