Provider Demographics
NPI:1013435338
Name:CANNON DRUGS LTD
Entity Type:Organization
Organization Name:CANNON DRUGS LTD
Other - Org Name:CANNON DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:STATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-956-5318
Mailing Address - Street 1:PO BOX 721
Mailing Address - Street 2:
Mailing Address - City:CHICKAMAUGA
Mailing Address - State:GA
Mailing Address - Zip Code:30707-0721
Mailing Address - Country:US
Mailing Address - Phone:706-956-5318
Mailing Address - Fax:706-956-5319
Practice Address - Street 1:357 LEE AND GORDON MILL RD
Practice Address - Street 2:
Practice Address - City:CHICKAMAUGA
Practice Address - State:GA
Practice Address - Zip Code:30707-1716
Practice Address - Country:US
Practice Address - Phone:706-956-5318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-07
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy