Provider Demographics
NPI:1578584546
Name:JAMES MCCOYS DRUG STORE SOUTH LLC
Entity Type:Organization
Organization Name:JAMES MCCOYS DRUG STORE SOUTH LLC
Other - Org Name:JAMES MCCOYS DRUG STORE SOUTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:TREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH PHARMD
Authorized Official - Phone:325-676-8900
Mailing Address - Street 1:1725 ANTILLEY RD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5204
Mailing Address - Country:US
Mailing Address - Phone:325-676-8900
Mailing Address - Fax:325-676-8905
Practice Address - Street 1:1725 ANTILLEY RD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5204
Practice Address - Country:US
Practice Address - Phone:325-676-8900
Practice Address - Fax:325-676-8905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332000000X, 333600000X, 3336C0004X, 3336S0011X
TX219753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2098944OtherPK