Provider Demographics
NPI:1598135568
Name:CANNON DRUG CO
Entity Type:Organization
Organization Name:CANNON DRUG CO
Other - Org Name:CANNON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST, PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:828-433-5120
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC045743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1285732412Medicaid
NC1285732412Medicaid