34D2006936 CLIA NUMBER - CANNON PHARMACY MOORESVILLE

Laboratory Demographics

  • CLIA Code: 34D2006936
  • Facility Name: CANNON PHARMACY MOORESVILLE
  • Facility Address: 521 E PLAZA DRIVE
    MOORESVILLE, NC
    ZIP 28115
  • Facility Phone: 704 658-9870
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RYAN T. YANICKO
  • NPI Number: 1811134869
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 34D2006936
LAB Type Pharmacy
Facility Name CANNON PHARMACY MOORESVILLE
Street 521 E PLAZA DRIVE
City MOORESVILLE
State NC
ZIP 28115
Phone 704 658-9870
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/5/2024
Certificate Expiration Date 5/4/2026
Facility Type Pharmacy
Lab Director RYAN T. YANICKO

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This page was last updated on: 9/29/2025