Provider Demographics
NPI:1538932421
Name:MCCOY, KEYZIAH
Entity type:Individual
Prefix:MS
First Name:KEYZIAH
Middle Name:
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 1:520 PUSEY AVE STE 520
Mailing Address - Street 2:
Mailing Address - City:COLLINGDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19023-3300
Mailing Address - Country:US
Mailing Address - Phone:610-461-3709
Mailing Address - Fax:
Practice Address - Street 1:520 PUSEY AVE STE 520
Practice Address - Street 2:
Practice Address - City:COLLINGDALE
Practice Address - State:PA
Practice Address - Zip Code:19023-3300
Practice Address - Country:US
Practice Address - Phone:610-461-3709
Practice Address - Fax:610-477-6576
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy