Provider Demographics
NPI:1023215613
Name:MCCOY, MICHEAL D (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:MICHEAL
Middle Name:D
Last Name:MCCOY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 471
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:24874-0471
Mailing Address - Country:US
Mailing Address - Phone:304-732-6969
Mailing Address - Fax:304-732-6866
Practice Address - Street 1:816 MAIN STREET, SUITE A
Practice Address - Street 2:
Practice Address - City:CHAPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508
Practice Address - Country:US
Practice Address - Phone:304-853-5554
Practice Address - Fax:304-853-5504
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV6579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist