=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447532460
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEYSTONE RURAL HEALTH CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2011
-----------------------------------------------------
Last Update Date | 03/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 830 5TH AVE STE 101
-----------------------------------------------------
City | CHAMBERSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17201-4224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-709-7977
-----------------------------------------------------
Fax | 717-709-7978
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 830 5TH AVE SUITE 101
-----------------------------------------------------
City | CHAMBERSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17201-4224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-217-6917
-----------------------------------------------------
Fax | 717-217-6995
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF PHARMACY SERVICES
-----------------------------------------------------
Name | CHARLES HILL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 717-261-4967
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PP482170
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------