Organization
PUBLIX TENNESSEE LLC
Active
Other names
Publix Pharmacy #1268
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
665 SOUTH MT.JULIET RD., MT. JULIET, TN 37122
(615) 773-0255
(615) 903-9053
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
4715
TN
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2123032
PK
—
Enumeration date
12/08/2009
Last updated
02/28/2024
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