Organization
PUBLIX SUPER MARKETS INC
Active
Other names
Publix Pharmacy #1278
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
955 STATE ROAD 16, ST AUGUSTINE, FL 32084-1857
(904) 819-6774
(904) 819-6872
Mailing address
PO BOX 639680, CINCINNATI, OH 45263-9680
(863) 688-1188
(863) 616-5846
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
PH24291
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001911600
—
FL
01
—
2122364
PK
—
Enumeration date
10/12/2009
Last updated
12/06/2019
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