CANNON PHARMACY MOORESVILLE DME
NPI 1164875340
Durable Medical Equipment & Medical Supplies - Customized Equipment in Mooresville, NC

Active since July 22, 2016CLIA 34D2006936 · Waiver
521 E PLAZA DR, MOORESVILLE, NC 28115(704) 658-9870(704) 658-9871 Get Directions Write a Review

NPPES record last updated: November 2, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Cannon Pharmacy Mooresville Dme NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CANNON PHARMACY MOORESVILLE DME (NPI 1164875340) is a healthcare organization registered as a customized equipment in Mooresville, North Carolina and active in the NPI registry since July 2016. The organization holds a CLIA Waiver certificate valid through May 4, 2028 and lists Ryan Yanicko, Pharmacist Owner, as its authorized official.

NPPES Registry Identity

NPI1164875340
Entity TypeOrganization
Primary Taxonomy332BC3200X
Legal Business NamePANTHER HEALTH, LLC
Location Address521 E PLAZA DRMooresville, NC 28115-8071
Mailing Address521 E Plaza DrMooresville, NC 28115-8071 · (704) 658-9870 · Fax (704) 658-9871
Fax(704) 658-9871
Organization SubpartNo
Authorized OfficialRyan YanickoPharmacist Owner · (704) 658-9870
Enumeration DateJuly 22, 2016
Last NPPES UpdateNovember 2, 2022
NPPES CertifiedNovember 2, 2022
NPI 1164875340 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Taxonomy Code332BC3200X
License Licensed in NC · 1225412562
521 E PLAZA DR, Mooresville, NC 28115

Other Names 1

Doing Business AsCannon Pharmacy Mooresville Dme

Other Identifiers 1

Medicaid1225412562NC

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 34D2006936

Cannon Pharmacy Mooresville · Mooresville, NC
Active · expires May 4, 2028
CLIA Number34D2006936
Laboratory TypePharmacy
Certificate Effective DateMay 5, 2026
Certificate Expiration DateMay 4, 2028
Laboratory DirectorRyan T. Yanicko
Laboratory Phone(704) 658-9870
Laboratory LocationCannon Pharmacy Mooresville521 E Plaza Drive, Mooresville, NC 28115
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Pharmacist
521 E PLAZA DR
MOORESVILLE, NC 28115
Pharmacy (Community/Retail Pharmacy)
521 E PLAZA DR
MOORESVILLE, NC 28115
Pharmacist
521 E PLAZA DR
MOORESVILLE, NC 28115
Pharmacist
521 E PLAZA DR
MOORESVILLE, NC 28115
Pharmacy (Long Term Care Pharmacy)
521 E PLAZA DR
MOORESVILLE, NC 28115
Pharmacy (Community/Retail Pharmacy)
521 E PLAZA DR
MOORESVILLE, NC 28115
Pharmacist
521 E PLAZA DR
MOORESVILLE, NC 28115

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Panther Health, LLC's NPI number?

The NPI number for Panther Health, LLC is 1164875340. It was assigned to this organization in the NPPES registry on July 22, 2016. The provider is doing business as Cannon Pharmacy Mooresville Dme.

Where is Panther Health, LLC located?

Panther Health, LLC is located at 521 E Plaza Dr, Mooresville, NC 28115. The listed phone number is (704) 658-9870.

What is Panther Health, LLC's specialty?

The primary specialty registered for this NPI is Durable Medical Equipment & Medical Supplies, specializing in Customized Equipment, with taxonomy code 332BC3200X.

Does Panther Health, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 34D2006936) is associated with this NPI, valid through May 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Panther Health, LLC was last updated on November 2, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.