Provider Demographics
NPI:1508569476
Name:MCCOY, MARISA CHRISTINA
Entity Type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:CHRISTINA
Last Name:MCCOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17989 CORKILL RD SPC 300
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92241-9441
Mailing Address - Country:US
Mailing Address - Phone:760-905-3055
Mailing Address - Fax:
Practice Address - Street 1:12900 PALM DR
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-4567
Practice Address - Country:US
Practice Address - Phone:760-905-3055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH83841183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician