NPIMap

Organization Active NPI

Panther Health, LLC

Doing business as Cannon Pharmacy Mooresville DME

  • Customized Equipment (DME)
  • Mooresville, NC
National Provider Identifier
1164875340
Registry record updated Nov 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Customized Equipment (DME)Taxonomy code 332BC3200X
License
1225412562 Issued in NC
Legal business name
PANTHER HEALTH, LLC
Doing business as
Cannon Pharmacy Mooresville DME
Practice address
521 E Plaza Dr
Mooresville, NC 28115-8071
Phone
(704) 658-9870
Fax
(704) 658-9871
NPI assigned
Jul 22, 2016
Last updated
Nov 2, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Ryan Yanicko, PHARMDNPI 1740565076
Title
Pharmacist Owner
Phone
(704) 658-9870

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Customized Equipment (DME) 332BC3200X 1225412562 NC Primary

Addresses

Primary practice location

521 E Plaza Dr
Mooresville, NC 28115-8071

Mailing address

521 E Plaza Dr
Mooresville, NC 28115-8071
Phone (704) 658-9870

Other identifiers 1

IdentifierTypeStateIssuer
1225412562MedicaidNC

Other names 1

  • Cannon Pharmacy Mooresville DME Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Cannon Pharmacy Mooresville2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1469145600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667347200000",
    "number": "1164875340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "521 E PLAZA DR",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281158071",
            "telephone_number": "704-658-9870",
            "fax_number": "704-658-9871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 E PLAZA DR",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281158071",
            "telephone_number": "704-658-9870",
            "fax_number": "704-658-9871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PANTHER HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-22",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A",
        "authorized_official_last_name": "YANICKO",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "PHARMACIST OWNER",
        "authorized_official_telephone_number": "704-658-9870",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "NC",
            "license": "1225412562",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1225412562",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cannon Pharmacy Mooresville DME",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cannon Pharmacy Mooresville DME",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mooresville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.