Provider Demographics
NPI:1548860802
Name:MCCOY, ADAM (PHARM D)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:MCCOY
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9240 N MERIDIAN ST STE 140
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2368
Mailing Address - Country:US
Mailing Address - Phone:317-343-2056
Mailing Address - Fax:
Practice Address - Street 1:9240 N MERIDIAN ST STE 140
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2368
Practice Address - Country:US
Practice Address - Phone:317-343-2056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.295704183500000X
VA0214002143183500000X
IN26027016A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist