Provider Demographics
NPI:1194988683
Name:MCCOY DAVIS, LISA MARIA (PHARMD)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIA
Last Name:MCCOY DAVIS
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 1:4910 34TH ST S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-4512
Mailing Address - Country:US
Mailing Address - Phone:727-867-4900
Mailing Address - Fax:727-867-4999
Practice Address - Street 1:1794 22ND ST S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33712-2752
Practice Address - Country:US
Practice Address - Phone:727-823-2309
Practice Address - Fax:727-821-3101
Is Sole Proprietor?:No
Enumeration Date:2008-07-06
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0026534183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS0026534OtherPHARMACY LICENSE