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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
13336C0003XCommunity/Retail PharmacyPH0027105FL

General Provider Information

NPI Number : 1518394477
Entity Type Code : Organization
Provider Name (Legal Business Name) : RURAL HEALTH CARE, INC.
Provider Business Mailing Address
First Line : PO BOX 817
Second Line :
City : PALATKA
State : FL
Zip : 32178-0817
Country : US
Telephone Number : 386-328-0108
Fax Number : 386-325-1086
Provider Business Practice Location Address
First Line : 1305 N ORANGE AVE
Second Line :
City : GREEN COVE SPRINGS
State : FL
Zip : 32043-2547
Country : US
Telephone Number : 904-284-5904
Fax Number : 904-284-5905
Authorized Official
Title or Position : VP/CPO
Name : MR. LARRY WILLIAM PEDERSON
Credential : RPH, CPH
Telephone Number : 386-328-0558
Provider Enumeration Date : 10/08/2013
Last Update Date : 02/13/2020

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