Organization
PUBLIX SUPER MARKETS INC
Active
Other names
Publix Pharmacy #1003
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
12855 NE 6TH AVE, NORTH MIAMI, FL 33161-4714
(305) 891-7054
(786) 646-9782
Mailing address
PO BOX 639680, CINCINNATI, OH 45263-9680
(863) 688-1188
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
PH30293
FL
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018496100
—
FL
05
—
018496101
—
FL
01
—
2159869
PK
—
Enumeration date
05/03/2016
Last updated
12/06/2019
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