Provider Demographics
NPI:1467472597
Name:CANNON, WILLIAM B (RPH)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:CANNON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 E PARKER RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-5111
Mailing Address - Country:US
Mailing Address - Phone:828-433-5120
Mailing Address - Fax:828-433-5149
Practice Address - Street 1:342 E PARKER RD
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-5111
Practice Address - Country:US
Practice Address - Phone:828-433-5120
Practice Address - Fax:828-433-5149
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06178183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0125369Medicaid
3423174OtherNCPDP
3423174OtherNCPDP