Organization
PUBLIX SUPER MARKETS INC
Active
Other names
Publix Pharmacy #0744
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
13015 BROWN BRIDGE RD, COVINGTON, GA 30016-9111
(678) 342-6939
(678) 342-7979
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
PHRE008439
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00880866A
—
GA
01
—
2020474
PK
—
Enumeration date
06/07/2006
Last updated
11/20/2019
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