Organization
PUBLIX SUPER MARKETS, INC.
Active
Other names
Publix Pharmacy #1768
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
1060 BRASELTON VILLAGE PKWY, BRASELTON, GA 30517
(678) 425-6206
(678) 368-4403
Mailing address
PO BOX 407, LAKELAND, FL 33802-0407
(863) 688-1188
(863) 616-5810
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE008686
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00858393F
—
GA
01
—
2014697
PK
—
Enumeration date
06/05/2006
Last updated
10/02/2025
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