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General NPI Number Information
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NPI Number | 1689756470
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Entity Type | Organization
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Legal Business Name | RURAL HEALTH CARE, INC.
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 02/07/2020
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Provider Practice Location Address
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Address Line | 306 UNION AVE
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City | CRESCENT CITY
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State | FL
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Zip | 32112-4432
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Country | US
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Telephone | 386-698-2368
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Fax | 386-698-4343
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Provider Business Mailing Address
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Address Line | PO BOX 817
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City | PALATKA
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State | FL
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Zip | 32178-0817
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP/CPO
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Name | LARRY WILLIAM PEDERSON
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Credential | RPH, CPH
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Telephone | 386-328-0558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PH0016495
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH0016495
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License Number State | FL
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