Organization
PUBLIX SUPER MARKETS, INC.
Active
Other names
Publix Pharmacy #1101
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP, PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
13850 LANDSTAR BLVD, ORLANDO, FL 32824-5526
(407) 856-6075
(407) 856-6048
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
PH0019905
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2007315
PK
—
05
—
212555200
—
FL
Enumeration date
06/05/2006
Last updated
02/01/2022
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