# PUBLIX SUPER MARKETS INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PUBLIX PHARMACY \#0535
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942240379
- **Authorized official:** SARAH POPE (CONTRACT ADMINISTRATOR)
- **Authorized official phone:** (863) 688-1188

## Contact information

- **Practice address:** 5158 MEMORIAL DR, STONE MOUNTAIN, GA 30083-3111
- **Practice address phone:** (770) 297-5016
- **Practice address fax:** (404) 297-1801
- **Mailing address:** 5158 MEMORIAL DR, STONE MOUNTAIN, GA 30083-3111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | PHRE007890 | GA | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 06/07/2006
- **Last updated:** 10/02/2007