Organization
PUBLIX SUPER MARKETS, INC
Active
Other names
Publix Pharmacy #1705
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
5810 SEVEN MILE DR, WILDWOOD, FL 34785-8854
(352) 461-5094
(352) 399-0247
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
—
—
Other
Enumeration date
02/13/2020
Last updated
10/15/2021
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