Healthcare Provider Details

I. General information

NPI: 1841541877
Provider Name (Legal Business Name): BERTIE COUNTY RURAL HEALTH ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 S. MAIN STREET
LEWISTON NC
27849-9694
US

IV. Provider business mailing address

PO BOX 39
LEWISTON NC
27849-0039
US

V. Phone/Fax

Practice location:
  • Phone: 252-348-2545
  • Fax: 252-348-2239
Mailing address:
  • Phone: 252-348-2545
  • Fax: 252-348-2239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHARONDA PUGH
Title or Position: CEO
Credential: MBA
Phone: 252-794-1835