Organization
PUBLIX SUPER MARKETS INC
Active
Other names
Publix Pharmacy #1090
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
5715 NW 7TH ST, MIAMI, FL 33126-3105
(305) 267-3362
(786) 574-5560
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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH29914
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017110600
—
FL
05
—
017110601
—
FL
01
—
2157261
PK
—
Enumeration date
12/31/2015
Last updated
12/06/2019
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