MEDICARE: MRS. SARA ANN MCCOY PHARMACY TECHNICIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183700000X	Pharmacy Technician	5303032726	MI
2	374U00000X	Home Health Aide	230014996500410	MI

General Provider Information

NPI Number	:	1750660288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARA ANN MCCOY PHARMACY TECHNICIAN

Provider Business Mailing Address
First Line	:	3751 S BERN RD
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-9235
Country	:	US
Telephone Number	:	989-443-1199
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 SPRUCE ST
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-3882
Country	:	US
Telephone Number	:	989-316-5434
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2011
Last Update Date	:	07/06/2021

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