Organization
PUBLIX SUPER MARKETS INC
Active
Other names
Publix Pharmacy #1524
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
7925 N KINGS HWY, MYRTLE BEACH, SC 29572-3056
(843) 449-1620
(843) 492-4278
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
16629
SC
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2160181
PK
—
05
—
716629
—
SC
Enumeration date
05/11/2016
Last updated
11/18/2019
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