Healthcare Provider Details

I. General information

NPI: 1497838551
Provider Name (Legal Business Name): RURAL HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 STATE ROAD 20
INTERLACHEN FL
32148-2737
US

IV. Provider business mailing address

PO BOX 817
PALATKA FL
32178-0817
US

V. Phone/Fax

Practice location:
  • Phone: 386-684-2407
  • Fax: 386-684-4701
Mailing address:
  • Phone: 386-328-0558
  • Fax: 386-328-9443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH11219
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

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