Healthcare Provider Details

I. General information

NPI: 1164561148
Provider Name (Legal Business Name): CANOTE PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 GAGE DRIVE SUITE K
HOLLISTER MO
65672
US

IV. Provider business mailing address

215 GAGE DRIVE SUITE K
HOLLISTER MO
65672
US

V. Phone/Fax

Practice location:
  • Phone: 417-334-9551
  • Fax:
Mailing address:
  • Phone: 417-334-9551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number2007002105
License Number StateMO

VIII. Authorized Official

Name: MR. BRIAN BURNEY
Title or Position: OWNER
Credential: R.PH.
Phone: 417-334-3187