Healthcare Provider Details

I. General information

NPI: 1720849540
Provider Name (Legal Business Name): NORTH FLORIDA RURAL HEALTH CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 MAPLE ST STE 100
CHATTAHOOCHEE FL
32324-1826
US

IV. Provider business mailing address

600 34TH ST S
ST PETERSBURG FL
33711-1722
US

V. Phone/Fax

Practice location:
  • Phone: 850-759-9223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: WALTER KYLES
Title or Position: CEO
Credential:
Phone: 850-999-3181