Provider Demographics
NPI:1164561148
Name:CANOTE PHARMACY, INC
Entity Type:Organization
Organization Name:CANOTE PHARMACY, INC
Other - Org Name:BRANSON DRUG COMPOUNDING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:417-334-3187
Mailing Address - Street 1:215 GAGE DRIVE
Mailing Address - Street 2:SUITE K
Mailing Address - City:HOLLISTER
Mailing Address - State:MO
Mailing Address - Zip Code:65672
Mailing Address - Country:US
Mailing Address - Phone:417-334-9551
Mailing Address - Fax:
Practice Address - Street 1:215 GAGE DRIVE
Practice Address - Street 2:SUITE K
Practice Address - City:HOLLISTER
Practice Address - State:MO
Practice Address - Zip Code:65672
Practice Address - Country:US
Practice Address - Phone:417-334-9551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070021053336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy