Organization
PUBLIX SUPER MARKETS INC
Active
Other names
Publix Pharmacy #1263
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
5451 BOWMAN RD, MACON, GA 31210-5783
(478) 477-2455
(478) 477-8775
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
PHRE009579
GA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2120625
PK
—
05
—
546833061A
—
GA
Enumeration date
06/12/2009
Last updated
11/18/2019
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