Provider Demographics
NPI:1073869889
Name:MCKOY, JONATHAN C (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:C
Last Name:MCKOY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 N MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-3347
Mailing Address - Country:US
Mailing Address - Phone:770-386-8160
Mailing Address - Fax:770-387-0694
Practice Address - Street 1:51 N MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121-3347
Practice Address - Country:US
Practice Address - Phone:770-386-8160
Practice Address - Fax:770-387-0694
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025565183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist