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Organization

PUBLIX SUPER MARKETS INC

Active
Other names
Publix Pharmacy #1610
Organization subpart
No

Provider details

NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization

Contact information

Practice address
5350 CENTRAL FLORIDA PKWY, ORLANDO, FL 32821-8772
(407) 550-9715
(407) 477-4473
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
PH31258
FL
3336C0003X
Community/Retail Pharmacy
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
024391900
FL
05
024391901
FL
01
2176581
PK
Enumeration date
02/09/2018
Last updated
10/15/2021
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