Healthcare Provider Details

I. General information

NPI: 1790950996
Provider Name (Legal Business Name): RONALD SCOTT MCKINNEY PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT 14 NORTH FOODMART SHOPPING CENTER
ELIZABETH WV
26143
US

IV. Provider business mailing address

PO BOX 74
ELIZABETH WV
26143-0074
US

V. Phone/Fax

Practice location:
  • Phone: 804-556-6225
  • Fax: 304-275-4502
Mailing address:
  • Phone: 304-275-4687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7345
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: