Organization
PUBLIX SUPER MARKETS INC
Active
Other names
Publix Pharmacy #1865, Publix Pharmacy #0455
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
1521 E KING AVE, KINGSLAND, GA 31548-1276
(912) 729-1457
(912) 439-5081
Mailing address
PO BOX 407, LAKELAND, FL 33802-0407
(863) 688-1188
(863) 616-5810
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE007659
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00570314B
—
GA
01
—
2018651
PK
—
Enumeration date
06/05/2006
Last updated
01/21/2026
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