Healthcare Provider Details

I. General information

NPI: 1306928197
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: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 COMMERCIAL DR
KEYSTONE HEIGHTS FL
32656-6802
US

IV. Provider business mailing address

100 COMMERCIAL DR
KEYSTONE HEIGHTS FL
32656-6802
US

V. Phone/Fax

Practice location:
  • Phone: 352-473-7243
  • Fax: 352-473-9149
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH19386
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH19386
License Number StateFL

VIII. Authorized Official

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