Organization
PUBLIX TENNESSEE LLC
Active
Other names
Publix Pharmacy #1515
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
2656 PARKWAY, PIGEON FORGE, TN 37863-3391
(865) 774-2034
(865) 366-0863
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
00005789
TN
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2159663
PK
—
Enumeration date
04/15/2016
Last updated
01/03/2020
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