Organization
PUBLIX SUPER MARKETS INC
Active
Other names
Publix Pharmacy #0350
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE RUSCH (MANAGER OF MANAGED CARE)
(863) 688-1188
Entity
Organization
Contact information
Practice address
4048 S SEMORAN BLVD, ORLANDO, FL 32822-4062
(407) 277-4848
(407) 277-2332
Mailing address
PO BOX 116181, ATLANTA, GA 30368-6181
(863) 688-1188
(863) 616-5846
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH0010283
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109953100
—
FL
01
—
2008950
PK
—
Enumeration date
06/06/2006
Last updated
08/03/2015
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