Provider Demographics
NPI:1083135685
Name:CANNON PHARMACY SALISBURY, LLC
Entity Type:Organization
Organization Name:CANNON PHARMACY SALISBURY, LLC
Other - Org Name:CANNON PHARMACY LONG TERM CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:K
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-886-0840
Mailing Address - Street 1:140 CABARRUS AVE W STE 26
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-5150
Mailing Address - Country:US
Mailing Address - Phone:704-886-0840
Mailing Address - Fax:704-933-6161
Practice Address - Street 1:1401 S. JAKE ALEXANDER BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28146-8359
Practice Address - Country:US
Practice Address - Phone:704-918-4833
Practice Address - Fax:704-380-1678
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CANNON HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-05
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0636330OtherUNEMPLOYMENT ID