Individual
MRS. TRACI REVELS MCCOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPH
Contact information
Practice address
702 W MAPLE AVE, GENEVA, AL 36340-1632
(334) 684-0453
(334) 684-9404
Mailing address
702 W MAPLE AVE, GENEVA, AL 36340-1632
(334) 684-0453
(334) 684-9404
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
102190
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100000662
—
AL
01
—
1730216417
NPI
—
Enumeration date
04/01/2010
Last updated
04/01/2010
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