Provider Demographics
NPI:1265468029
Name:RSM PHARMACY INC
Entity Type:Organization
Organization Name:RSM PHARMACY INC
Other - Org Name:CARDINAL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:304-275-4687
Mailing Address - Street 1:PO BOX 74
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:WV
Mailing Address - Zip Code:26143-0074
Mailing Address - Country:US
Mailing Address - Phone:304-275-4687
Mailing Address - Fax:304-275-4502
Practice Address - Street 1:483 COURT ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:WV
Practice Address - Zip Code:26143-1109
Practice Address - Country:US
Practice Address - Phone:304-275-4687
Practice Address - Fax:304-275-4502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
WVSP05523973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810016847Medicaid
2124036OtherPK
WV3810016847Medicaid