MEDICARE: MR. RAYMOND NEALE COY JR. D.PH.

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	8661	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8661	OTHER	OK	PHARMACY LISCENSE

General Provider Information

NPI Number	:	1831191600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAYMOND NEALE COY JR. D.PH.

Provider Business Mailing Address
First Line	:	PO BOX 98
Second Line	:
City	:	HARRAH
State	:	OK
Zip	:	73045-0098
Country	:	US
Telephone Number	:	405-454-6261
Fax Number	:	405-454-6262

Provider Business Practice Location Address
First Line	:	19655 NE 23RD ST
Second Line	:
City	:	HARRAH
State	:	OK
Zip	:	73045-9305
Country	:	US
Telephone Number	:	405-454-6261
Fax Number	:	405-454-6262

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/08/2007

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