Provider Demographics
NPI:1336142967
Name:MCCOY, RICHARD C JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:C
Last Name:MCCOY
Suffix:JR
Gender:M
Credentials:RPH
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 190
Mailing Address - Street 2:
Mailing Address - City:LOPEZ ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98261-0190
Mailing Address - Country:US
Mailing Address - Phone:360-468-2616
Mailing Address - Fax:360-468-3825
Practice Address - Street 1:352 LOPEZ ROAD
Practice Address - Street 2:
Practice Address - City:LOPEZ ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98261-0190
Practice Address - Country:US
Practice Address - Phone:360-468-2616
Practice Address - Fax:360-468-3825
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA20518183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA20518OtherWA R.PH. LICENSE