Organization
PUBLIX SUPER MARKETS INC
Active
Other names
Publix Pharmacy #1147
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
2481 DEL PRADO BLVD N, CAPE CORAL, FL 33909-4002
(239) 573-1832
(239) 573-6304
Mailing address
PO BOX 639680, CINCINNATI, OH 45263-9680
(863) 688-1188
(863) 616-5846
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH22920
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
032270900
—
FL
01
—
2009767
PK
—
Enumeration date
09/07/2007
Last updated
06/21/2023
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