Provider Demographics
NPI:1568428845
Name:MCCOY, JENNIFER FUTCH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:FUTCH
Last Name:MCCOY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 COLONY LN
Mailing Address - Street 2:
Mailing Address - City:BROOKLET
Mailing Address - State:GA
Mailing Address - Zip Code:30415-6172
Mailing Address - Country:US
Mailing Address - Phone:912-842-5806
Mailing Address - Fax:
Practice Address - Street 1:1499 FAIR RD
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-1683
Practice Address - Country:US
Practice Address - Phone:912-486-1640
Practice Address - Fax:912-871-2428
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH-021263183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist