Organization
PUBLIX SUPER MARKETS INC
Active
Other names
Publix Pharmacy #0252
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
8842 W STATE ROAD 84, DAVIE, FL 33324-4415
(954) 423-9460
(754) 701-6511
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
PH30012
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017304800
—
FL
05
—
017304801
—
FL
01
—
2158329
PK
—
Enumeration date
02/22/2016
Last updated
11/21/2019
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