Organization
PUBLIX SUPER MARKETS INC
Active
Other names
Publix Pharmacy #1412
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
8360 CHARLOTTE HWY, INDIAN LAND, SC 29707-6532
(803) 548-9033
(864) 214-2868
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
14208
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2137206
PK
—
05
—
714208
—
SC
Enumeration date
09/18/2012
Last updated
11/18/2019
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