Organization
PUBLIX TENNESSEE LLC
Active
Other names
Publix Pharmacy #0142
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
8105 MOORES LN, BRENTWOOD, TN 37027-8020
(615) 221-9982
(615) 221-9082
Mailing address
PO BOX 639680, CINCINNATI, OH 45263-9680
(863) 688-1188
(863) 616-5846
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
3858
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2093888
PK
—
05
—
Q035937
—
TN
Enumeration date
06/08/2006
Last updated
01/03/2020
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