Provider Demographics
NPI:1003440389
Name:JAMES MCCOY'S MIDTOWN DRUG STORE, INC
Entity Type:Organization
Organization Name:JAMES MCCOY'S MIDTOWN DRUG STORE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HEUERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:325-232-8866
Mailing Address - Street 1:1417 SOUTH WILLIS ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605
Mailing Address - Country:US
Mailing Address - Phone:325-232-8866
Mailing Address - Fax:325-232-8870
Practice Address - Street 1:1417 S WILLIS
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605
Practice Address - Country:US
Practice Address - Phone:325-232-8866
Practice Address - Fax:325-232-8870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33129OtherTEXAS STATE BOARD OF PHARMACY