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NPI Code Detail

MEDICARE: RURAL HEALTH CARE, INC.

MEDICARE: RURAL HEALTH CARE, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacyPH19386FL
23336C0003XCommunity/Retail PharmacyPH19386FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
31099488OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1306928197
Entity Type Code : Organization
Provider Name (Legal Business Name) : RURAL HEALTH CARE, INC.
Provider Business Mailing Address
First Line : 100 COMMERCIAL DR
Second Line :
City : KEYSTONE HEIGHTS
State : FL
Zip : 32656-6802
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 100 COMMERCIAL DR
Second Line :
City : KEYSTONE HEIGHTS
State : FL
Zip : 32656-6802
Country : US
Telephone Number : 352-473-7243
Fax Number : 352-473-9149
Authorized Official
Title or Position : CHIEF PHARMACY OFFICER
Name : LARRY WILLIAM PEDERSON
Credential : RPH
Telephone Number : 386-328-0558
Provider Enumeration Date : 10/20/2006
Last Update Date : 02/13/2020

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Directions to “RURAL HEALTH CARE, INC. ” Practice Location

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