Provider Demographics
NPI:1528204419
Name:RURAL HEALTH CARE, INCORPORATED
Entity Type:Organization
Organization Name:RURAL HEALTH CARE, INCORPORATED
Other - Org Name:AZA HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP/CPO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:PEDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:AA,BA,BSP
Authorized Official - Phone:386-328-0558
Mailing Address - Street 1:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32178-0817
Mailing Address - Country:US
Mailing Address - Phone:386-328-0558
Mailing Address - Fax:386-328-9443
Practice Address - Street 1:22066 SE 71ST AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:FL
Practice Address - Zip Code:32640-3969
Practice Address - Country:US
Practice Address - Phone:352-481-5640
Practice Address - Fax:352-481-5641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH23758333600000X
FLPH00237583336C0003X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
935OtherNCPDP CHAIN CODE
1041071OtherNCPDP
FL000602300Medicaid
FL000602300Medicaid