Healthcare Provider Details

I. General information

NPI: 1689756470
Provider Name (Legal Business Name): RURAL HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 UNION AVE
CRESCENT CITY FL
32112-4432
US

IV. Provider business mailing address

PO BOX 817
PALATKA FL
32178-0817
US

V. Phone/Fax

Practice location:
  • Phone: 386-698-2368
  • Fax: 386-698-4343
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH0016495
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH0016495
License Number StateFL

VIII. Authorized Official

Name: LARRY WILLIAM PEDERSON
Title or Position: VP/CPO
Credential: RPH, CPH
Phone: 386-328-0558