Organization
RURAL HEALTH CARE, INCORPORATED
Active
Other names
Aza Health
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY W PEDERSON AA,BA,BSP (VP/CPO)
(386) 328-0558
Entity
Organization
Contact information
Practice address
22066 SE 71ST AVE, HAWTHORNE, FL 32640-3969
(352) 481-5640
(352) 481-5641
Mailing address
PO BOX 817, PALATKA, FL 32178-0817
(386) 328-0558
(386) 328-9443
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PH23758
FL
3336C0003X
Community/Retail Pharmacy
Primary
PH0023758
FL
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000602300
—
FL
01
—
1041071
NCPDP
—
01
—
935
NCPDP CHAIN CODE
—
Enumeration date
12/23/2008
Last updated
03/07/2023
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