Organization
PUBLIX TENNESSEE, LLC
Active
Other names
Publix Pharmacy 1633
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
509 N STATE OF FRANKLIN RD STE 20, JOHNSON CITY, TN 37604-8215
(423) 328-5119
(423) 328-1138
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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
01/22/2021
Last updated
05/21/2021
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