Provider Demographics
NPI:1871113993
Name:MCCOY, JENNIFER LEEANN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEEANN
Last Name:MCCOY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 S MOUNT AUBURN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-4931
Mailing Address - Country:US
Mailing Address - Phone:573-651-5250
Mailing Address - Fax:573-651-5230
Practice Address - Street 1:465 S MOUNT AUBURN RD STE 101
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-4931
Practice Address - Country:US
Practice Address - Phone:573-651-5250
Practice Address - Fax:573-651-5230
Is Sole Proprietor?:No
Enumeration Date:2020-04-18
Last Update Date:2020-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006002748183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist