Organization
PUBLIX SUPER MARKETS INC
Active
Other names
Publix Pharmacy #2011
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
103 MIRROR LAKE CONNECTOR STE 200, VILLA RICA, GA 30180-3250
(678) 840-8788
(678) 840-8786
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
PHRE008805
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2015543
PK
—
05
—
253206699A
—
GA
01
—
PHRE011166
STATE PHARMACY LICENSE
GA
Enumeration date
06/05/2006
Last updated
04/24/2024
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