Organization
PUBLIX SUPER MARKETS INC
Active
Other names
Publix Pharmacy #1227
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
3120 MATHIS AIRPORT PKWY, SUWANEE, GA 30024-9128
(770) 781-4640
(770) 781-8513
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
PHRE009521
GA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2117534
PK
—
05
—
914700735A
—
GA
Enumeration date
10/21/2008
Last updated
01/03/2020
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