Organization
PUBLIX SUPER MARKETS, INC.
Active
Other names
Publix Pharmacy #1313
Organization subpart
No
Provider details
NPI number
Authorized official
FRED OTTOLINO RPH (VP OF PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
2381 W STATE ROAD 434, LONGWOOD, FL 32779-4984
(407) 862-5414
(407) 862-5898
Mailing address
2381 W STATE ROAD 434, LONGWOOD, FL 32779-4984
(407) 862-5414
(407) 862-5898
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000731800
—
FL
01
—
000731801
FLORIDA MEDICAID DME NUMBER
FL
01
—
1038757
NCPDP
—
Enumeration date
10/14/2008
Last updated
04/03/2009
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