Organization
PUBLIX SUPER MARKETS INC
Active
Other names
Publix Pharmacy #1494
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
1500 SW 57TH AVE, WEST MIAMI, FL 33144-5722
(305) 265-8255
(786) 574-5579
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
PH30059
FL
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017255600
—
FL
05
—
017255601
—
FL
01
—
2159164
PK
—
Enumeration date
03/25/2016
Last updated
12/03/2019
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