Provider Demographics
NPI:1578863262
Name:MCCOY, KATHY RAY (RPH)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:RAY
Last Name:MCCOY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-1419
Mailing Address - Country:US
Mailing Address - Phone:719-384-6616
Mailing Address - Fax:719-384-7610
Practice Address - Street 1:315 W 2ND ST
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-1419
Practice Address - Country:US
Practice Address - Phone:719-384-6616
Practice Address - Fax:719-384-7610
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist