34D1102919 CLIA NUMBER - CANNON PHARMACY

Laboratory Demographics

CLIA Number: 34D1102919

Facility Name: CANNON PHARMACY

Facility Address:
1402 N CANNON BLVD
KANNAPOLIS, NC
ZIP 28083
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Facility Phone Number: 704 933-7948

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1730358896

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	34D1102919
LAB Type	Pharmacy
Facility Name	CANNON PHARMACY
Street	1402 N CANNON BLVD
City	KANNAPOLIS
State	NC
ZIP	28083
Phone	704 933-7948
CertificateType	4
CertificateEffectiveDate	7/29/2023
CertificateExpirationDate	7/28/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024