Organization
PUBLIX SUPER MARKETS INC
Active
Other names
PUBLIX PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DALE HOUSTON (MANAGER OF MANAGED CARE)
(863) 688-1188
Entity
Organization
Contact information
Practice address
5858 ATLANTIC BLVD, JACKSONVILLE, FL 32207-2223
(904) 724-3502
(904) 724-3788
Mailing address
PO BOX 116181, ATLANTA, GA 30368-6181
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PH0020776
FL
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
026936100
—
FL
01
—
026936101
MEDICAID DME
FL
01
—
1006798
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
06/07/2006
Last updated
04/17/2009
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