Panther Health LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

12647 Issued in NC

Legal business name

PANTHER HEALTH LLC

Doing business as

Cannon Pharmacy Mooresville

Practice address

521 E Plaza Dr
Mooresville, NC 28115-8071

Phone

(704) 658-9870

Fax

(704) 658-9871

NPI assigned

Jul 16, 2015

Last updated

Nov 2, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ryan Yanicko, PHARMDNPI 1740565076

Title

Manager/Pharmacist

Phone

(704) 658-9870

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Cannon Pharmacy Mooresville Doing business as

Medicare fee-for-service enrollment

Enrolled in NC2 enrollments

Enrollment records 2

Locations

Practitioners 3

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.

• Ryan Thomas Yanicko, PHARM.D.

  • Pharmacist
  • Mooresville, NC
  • NPI 1740565076
  NPD (past) Authorized official
• Brian William Rebholz, PHARM.D.

  • Pharmacist
  • Mooresville, NC
  • NPI 1043538515
  NPD (past)
• Kimberly Rowland White, RPH

  • Pharmacist
  • Mooresville, NC
  • NPI 1972839025
  NPD (past)

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

{
    "created_epoch": "1437004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667347200000",
    "number": "1225412562",
    "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": "2015-07-16",
        "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": "MANAGER/PHARMACIST",
        "authorized_official_telephone_number": "704-658-9870",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "12647",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1225412562",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2153237",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cannon Pharmacy Mooresville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Melinda Padmore, LCSW
• Leslie Palliere, MS-CCC/SLP
• Luis Alejandro Palma III, CCHT, RMT
• Roberto Palmieri, DMD
• Pamela J Meeds Psy D PA
• Panther Health, LLC (Cannon Pharmacy Mooresville DME)
• Panther Health, LLC (Cannon Pharmacy Mooresville)
• Rebecca McElhannon Panuski, M.D.
• Dannielle Cathleen Panzeter, CRNA
• Nicole Pappalardo

• Community/Retail Pharmacy in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Community/Retail Pharmacy in North Carolina

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.