Provider Demographics
NPI:1891678231
Name:MCCOY, PAMELA ROSE
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ROSE
Last Name:MCCOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15628 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-3413
Mailing Address - Country:US
Mailing Address - Phone:740-624-3190
Mailing Address - Fax:
Practice Address - Street 1:15025 N THOMPSON PEAK PKWY
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2863
Practice Address - Country:US
Practice Address - Phone:480-551-6429
Practice Address - Fax:480-551-7073
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTR02887183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician