Organization
PUBLIX SUPER MARKETS INC
Active
Other names
Publix Pharmacy #0545
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE RUSCH (MANAGER OF MANAGED CARE)
(863) 688-1188
Entity
Organization
Contact information
Practice address
11155 TARA BLVD, HAMPTON, GA 30228-1672
(770) 473-6886
(770) 473-4716
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
PHRE007931
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00685748A
—
GA
01
—
2019234
PK
—
Enumeration date
06/07/2006
Last updated
08/04/2015
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