Provider Demographics
NPI:1447547732
Name:MCCOY, REGINALD JAMES JR (CPHT, MBA, MPA)
Entity type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:JAMES
Last Name:MCCOY
Suffix:JR
Gender:M
Credentials:CPHT, MBA, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-1526
Mailing Address - Country:US
Mailing Address - Phone:708-731-4400
Mailing Address - Fax:
Practice Address - Street 1:1101 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1526
Practice Address - Country:US
Practice Address - Phone:708-731-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL049-140059183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician