Organization
PUBLIX SUPER MARKETS INC
Active
Other names
Publix Pharmacy #3210
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
12902 USF MAGNOLIA DR, SUITE 1170, TAMPA, FL 33612-9416
(813) 745-8484
(813) 745-1740
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
PH26169
FL
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005538200
—
FL
05
—
005538201
—
FL
01
—
2135204
PK
—
Enumeration date
04/02/2012
Last updated
10/15/2020
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