Healthcare Provider Details

I. General information

NPI: 1336105634
Provider Name (Legal Business Name): RURAL RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MAIN STREET
COON RAPIDS IA
50058
US

IV. Provider business mailing address

400 N ELM ST
JEFFERSON IA
50129-1420
US

V. Phone/Fax

Practice location:
  • Phone: 712-999-6337
  • Fax: 712-999-7979
Mailing address:
  • Phone: 575-386-2164
  • Fax: 515-386-8521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA YOUNGBLOOD
Title or Position: OWNER/PIC
Credential: PHARM. D.
Phone: 515-386-2164