MEDICARE: MRS. DANA PERRY MCCOY RPH

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	183500000X	Pharmacist	PS34012	FL

General Provider Information

NPI Number	:	1710176813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANA PERRY MCCOY RPH

Provider Business Mailing Address
First Line	:	13757 86TH TER
Second Line	:
City	:	LIVE OAK
State	:	FL
Zip	:	32060-9013
Country	:	US
Telephone Number	:	386-364-5871
Fax Number	:

Provider Business Practice Location Address
First Line	:	3718 W US HIGHWAY 90
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-4897
Country	:	US
Telephone Number	:	386-755-9300
Fax Number	:

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

Provider Enumeration Date	:	10/15/2007
Last Update Date	:	03/12/2008

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