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General NPI Number Information
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NPI Number | 1164561148
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Entity Type | Organization
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Legal Business Name | CANOTE PHARMACY, INC
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 215 GAGE DRIVE SUITE K
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City | HOLLISTER
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State | MO
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Zip | 65672
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Country | US
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Telephone | 417-334-9551
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Fax |
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Provider Business Mailing Address
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Address Line | 215 GAGE DRIVE SUITE K
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City | HOLLISTER
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State | MO
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Zip | 65672
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Country | US
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Telephone | 417-334-9551
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRIAN BURNEY
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Credential | R.PH.
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Telephone | 417-334-3187
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 2007002105
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License Number State | MO
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