NPIMap

Organization Active NPI

Livewell Inc

Doing business as Cannon Pharmacy Morrocroft

  • Community/Retail Pharmacy
  • Charlotte, NC
National Provider Identifier
1558468488
Registry record updated Jan 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
7883 Issued in NC
Legal business name
LIVEWELL INC
Doing business as
Cannon Pharmacy Morrocroft
Practice address
4501 Cameron Valley Pkwy Ste 125
Charlotte, NC 28211-4299
Phone
(704) 367-7440
Fax
(704) 365-2345
NPI assigned
Sep 20, 2006
Last updated
Jan 23, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2013

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

Authorized official

Name
Kristen Dinan, RPH
Title
Pharmacist Manager Owner
Phone
(704) 367-7440

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 7883 NC Primary

Addresses

Primary practice location

4501 Cameron Valley Pkwy Ste 125
Charlotte, NC 28211-4299

Mailing address

4501 Cameron Valley Pkwy Ste 125
Suite 125
Charlotte, NC 28211-4299
Phone (704) 367-7440

Other identifiers 2

IdentifierTypeStateIssuer
0609491MedicaidNC
3427196OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • Cannon Pharmacy Morrocroft Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Cannon Pharmacy3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

4501 Cameron Valley Pkwy
Ste 125
Charlotte, NC 28211
Phone (704) 367-7440

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": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358899200000",
    "number": "1558468488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4501 CAMERON VALLEY PKWY STE 125",
            "address_2": "SUITE 125",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282114299",
            "telephone_number": "704-367-7440",
            "fax_number": "704-365-2345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4501 CAMERON VALLEY PKWY STE 125",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282114299",
            "telephone_number": "704-367-7440",
            "fax_number": "704-365-2345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVEWELL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2013-01-23",
        "status": "A",
        "authorized_official_last_name": "DINAN",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_title_or_position": "PHARMACIST MANAGER OWNER",
        "authorized_official_telephone_number": "704-367-7440",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NC",
            "license": "7883",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0609491",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "3427196",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cannon Pharmacy Morrocroft",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2013; 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.