Organization
PUBLIX SUPER MARKETS INC
Active
Other names
Publix Pharmacy #1251
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
916 LOGANVILLE HWY, SUITE 200, BETHLEHEM, GA 30620-2144
(770) 307-1637
(770) 545-6591
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
PHRE9573
GA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2119699
PK
—
05
—
293157156A
—
GA
Enumeration date
03/31/2009
Last updated
10/27/2022
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