Healthcare Provider Details

I. General information

NPI: 1801427711
Provider Name (Legal Business Name): BERTIE COUNTY RURAL HEALTH ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2020
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 RHODES AVE
WINDSOR NC
27983-9656
US

IV. Provider business mailing address

PO BOX 628
WINDSOR NC
27983-0628
US

V. Phone/Fax

Practice location:
  • Phone: 252-794-3042
  • Fax:
Mailing address:
  • Phone: 252-794-1835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SHAVONDA H PUGH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 252-794-1835