Provider Demographics
NPI:1710176813
Name:MCCOY, DANA PERRY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:PERRY
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 1:13757 86TH TER
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32060-9013
Mailing Address - Country:US
Mailing Address - Phone:386-364-5871
Mailing Address - Fax:
Practice Address - Street 1:3718 W US HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-4897
Practice Address - Country:US
Practice Address - Phone:386-755-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34012183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist