Provider Demographics
NPI:1861093734
Name:MCCOY, DOROTHY DENISE (PHARM D)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:DENISE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:DENISE
Other - Last Name:MCCOY-SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:6181 DORSET RD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-1106
Mailing Address - Country:US
Mailing Address - Phone:135-244-2541
Mailing Address - Fax:
Practice Address - Street 1:13360 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-4887
Practice Address - Country:US
Practice Address - Phone:352-592-4795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist