Organization
PUBLIX NORTH CAROLINA LP
Active
Other names
Publix Pharmacy #1514
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
1030 FORESTVILLE RD, WAKE FOREST, NC 27587-9361
(919) 556-7124
(919) 263-3846
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
13034
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2163686
PK
—
Enumeration date
08/18/2016
Last updated
01/03/2020
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