Healthcare Provider Details

I. General information

NPI: 1972609584
Provider Name (Legal Business Name): MCCOY'S PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 E MAIN ST
COTTAGE GROVE OR
97424-2038
US

IV. Provider business mailing address

632 E MAIN ST
COTTAGE GROVE OR
97424-2038
US

V. Phone/Fax

Practice location:
  • Phone: 541-942-4453
  • Fax: 541-942-4454
Mailing address:
  • Phone: 541-942-4453
  • Fax: 541-942-4454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8454
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number8454
License Number StateOR

VIII. Authorized Official

Name: MR. DAVID ANTONINO DEBYSINGH
Title or Position: PRESIDENT
Credential: RPH
Phone: 541-942-4453