Organization
PUBLIX PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN KUSHNER (DISTRICT SUPERVISOR)
(941) 626-0476
Entity
Organization
Contact information
Practice address
7290 55TH AVE E, BRADENTON, FL 34203-8002
(941) 727-8808
Mailing address
7290 55TH AVE E, BRADENTON, FL 34203-8002
(941) 727-8808
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
PS54097
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PS54097
STATE LICENSE ID
FL
Enumeration date
10/06/2015
Last updated
10/06/2015
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