Provider Demographics
NPI:1285746313
Name:CANOTE PHARMACY INC
Entity type:Organization
Organization Name:CANOTE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BURNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:417-334-3187
Mailing Address - Street 1:101 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-2713
Mailing Address - Country:US
Mailing Address - Phone:417-334-3187
Mailing Address - Fax:417-336-4939
Practice Address - Street 1:101 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-2713
Practice Address - Country:US
Practice Address - Phone:417-334-3187
Practice Address - Fax:417-336-4939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003453332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO600203616Medicaid
MO620203620Medicaid
MO620203620Medicaid