Organization
PUBLIX SUPER MARKETS, INC.
Active
Other names
Publix Pharmacy #1684
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
155 BARTRAM PARK DRIVE, SUITE 100, ST. JOHNS, FL 32259
(160) 942-5826
Mailing address
PO BOX 116181, ATLANTA, GA 30368-6181
(863) 688-1188
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
09/10/2019
Last updated
12/13/2019
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