Provider Demographics
NPI:1306114509
Name:MCCOY, JOHN EUGENE I
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EUGENE
Last Name:MCCOY
Suffix:I
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JACK
Other - Middle Name:EUGENE
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:1311 N STATE ROUTE 48
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-3701
Mailing Address - Country:US
Mailing Address - Phone:217-429-1988
Mailing Address - Fax:217-429-9577
Practice Address - Street 1:1311 N STATE ROUTE 48
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-3701
Practice Address - Country:US
Practice Address - Phone:217-429-1988
Practice Address - Fax:217-429-9577
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051026073183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist