1043765092 NPI number — AMANDA BOYKIN MCCOY PHARMD

Table of content: AMANDA BOYKIN MCCOY PHARMD (NPI 1043765092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043765092 NPI number — AMANDA BOYKIN MCCOY PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYKIN MCCOY
Provider First Name:
AMANDA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOYKIN
Provider Other First Name:
AMANDA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043765092
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
145 GATHERING PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27713-6157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
984-974-6530
Provider Business Mailing Address Fax Number:
866-477-1421

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1025 THINK PLACE
Provider Second Line Business Practice Location Address:
4TH FLOOR SUITE 460
Provider Business Practice Location Address City Name:
MORRISVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
984-974-6530
Provider Business Practice Location Address Fax Number:
866-477-1421
Provider Enumeration Date:
08/19/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  25316 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 183500000X , with the licence number: 017922 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)