Provider Demographics
NPI:1639485949
Name:MCCOY, JAMES THOMAS (BS PHARM)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:THOMAS
Last Name:MCCOY
Suffix:
Gender:M
Credentials:BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26630 BARTON RD APT 722
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4325
Mailing Address - Country:US
Mailing Address - Phone:951-809-2208
Mailing Address - Fax:
Practice Address - Street 1:26630 BARTON RD APT 722
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4325
Practice Address - Country:US
Practice Address - Phone:951-809-2208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35826183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist