Healthcare Provider Details

I. General information

NPI: 1487150009
Provider Name (Legal Business Name): RURAL HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2018
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 DUNN AVE
DAYTONA BEACH FL
32114-1437
US

IV. Provider business mailing address

1302 RIVER ST
PALATKA FL
32177-5042
US

V. Phone/Fax

Practice location:
  • Phone: 386-323-9808
  • Fax: 386-323-9810
Mailing address:
  • Phone: 386-328-0558
  • Fax: 386-328-9443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH31307
License Number StateFL

VIII. Authorized Official

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