Healthcare Provider Details

I. General information

NPI: 1659417202
Provider Name (Legal Business Name): CANNONS DISCOUNT PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13351 E ALESSI RD
INDEPENDENCE LA
70443-2398
US

IV. Provider business mailing address

13351 E ALESSI RD
INDEPENDENCE LA
70443-2398
US

V. Phone/Fax

Practice location:
  • Phone: 985-878-5555
  • Fax: 985-878-5553
Mailing address:
  • Phone: 985-878-5555
  • Fax: 985-878-5553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY.005972-IR
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHARLES R. CANNON III
Title or Position: MANAGING MEMBER
Credential: PHARMD
Phone: 985-878-5555