Provider Demographics
NPI:1972609584
Name:MCCOY'S PHARMACY INC
Entity Type:Organization
Organization Name:MCCOY'S PHARMACY INC
Other - Org Name:MCCOY'S PHARMACY & GIFT SHOP
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANTONINO
Authorized Official - Last Name:DEBYSINGH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:541-942-4453
Mailing Address - Street 1:632 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-2038
Mailing Address - Country:US
Mailing Address - Phone:541-942-4453
Mailing Address - Fax:541-942-4454
Practice Address - Street 1:632 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-2038
Practice Address - Country:US
Practice Address - Phone:541-942-4453
Practice Address - Fax:541-942-4454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR8454183500000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR119578Medicaid
OR3801481OtherNABP
OR269468Medicare ID - Type Unspecified
OR133040Medicare PIN
OR0199840001Medicare NSC