Provider Demographics
NPI:1568068666
Name:MCCOY-BROWN, VICKI
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:MCCOY-BROWN
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:PO BOX 2344
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73023-2344
Mailing Address - Country:US
Mailing Address - Phone:405-274-1324
Mailing Address - Fax:
Practice Address - Street 1:2001 S 1ST ST
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-6007
Practice Address - Country:US
Practice Address - Phone:405-224-0292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12759183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist