Provider Demographics
NPI:1679246516
Name:MCCOY, ALYSIA MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALYSIA
Middle Name:MARIE
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:PO BOX 2550
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:AR
Mailing Address - Zip Code:72921-2550
Mailing Address - Country:US
Mailing Address - Phone:479-262-2156
Mailing Address - Fax:479-262-2264
Practice Address - Street 1:110 FAYETTEVILLE AVE
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:AR
Practice Address - Zip Code:72921-3654
Practice Address - Country:US
Practice Address - Phone:479-262-2156
Practice Address - Fax:479-262-2264
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD09518183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist