Organization
PUBLIX SUPER MARKETS INC
Active
Other names
Publix Pharmacy #1464
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
479 BYPASS 72 NW STE 100, GREENWOOD, SC 29649-1405
(864) 223-8909
(864) 538-6489
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
15338
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2147817
PK
—
05
—
715338
—
SC
Enumeration date
08/29/2014
Last updated
11/18/2019
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