Organization
PUBLIX SUPER MARKETS INC
Active
Other names
Publix Pharmacy #1248
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
15 LAUREL CANYON VILLAGE CIR., SUITE 118, CANTON, GA 30114
(770) 479-3711
(770) 882-0163
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
PHRE009600
GA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2121903
PK
—
05
—
862849293A
—
GA
Enumeration date
09/10/2009
Last updated
10/27/2022
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