Healthcare Provider Details

I. General information

NPI: 1588993695
Provider Name (Legal Business Name): CARDINAL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2009
Last Update Date: 12/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT 14 NORTH
ELIZABETH WV
26143
US

IV. Provider business mailing address

PO BOX 74
ELIZABETH WV
26143-0074
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberSP0552397
License Number StateWV

VIII. Authorized Official

Name: DR. RONALD SCOTT MCKINNEY
Title or Position: PHARMACIST/OWNER
Credential: PHARM D
Phone: 304-275-4687