Provider Demographics
NPI:1134419393
Name:MCCOY, COLLEEN WYNN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:WYNN
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 1:6239 N TRIGONIA RD
Mailing Address - Street 2:
Mailing Address - City:GREENBACK
Mailing Address - State:TN
Mailing Address - Zip Code:37742-2016
Mailing Address - Country:US
Mailing Address - Phone:865-856-6313
Mailing Address - Fax:
Practice Address - Street 1:856 HIGHWAY 411 N
Practice Address - Street 2:
Practice Address - City:ETOWAH
Practice Address - State:TN
Practice Address - Zip Code:37331-1912
Practice Address - Country:US
Practice Address - Phone:423-263-5656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist