Organization
PUBLIX SUPER MARKETS INC
Active
Other names
Publix Pharmacy #1540
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
378 VETERANS PKWY N, MOULTRIE, GA 31788-4171
(229) 217-4816
(229) 785-8246
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
PHRE010315
GA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003182546A
—
GA
01
—
2164497
PK
—
Enumeration date
09/01/2016
Last updated
11/18/2019
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