Provider Demographics
NPI:1811469372
Name:CANNON PHARMACY SALISBURY, LLC
Entity type:Organization
Organization Name:CANNON PHARMACY SALISBURY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
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:980-892-0700
Mailing Address - Street 1:140 CABARRUS AVE W STE 23
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:980-892-0700
Practice Address - Fax:980-892-0750
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CANNON HEALTH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-21
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy