Provider Demographics
NPI:1124469358
Name:MCCOY, DANIEL R (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
Last Name:MCCOY
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 JUNCTION RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-2615
Mailing Address - Country:US
Mailing Address - Phone:608-827-9483
Mailing Address - Fax:608-827-9483
Practice Address - Street 1:750 HILLDALE WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2644
Practice Address - Country:US
Practice Address - Phone:608-807-3979
Practice Address - Fax:608-807-3989
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17121-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist