Organization
PUBLIX SUPER MARKETS INC
Active
Other names
Publix Pharmacy #1405
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
501 SE 18TH AVE, BOYNTON BEACH, FL 33435-6949
(561) 292-4085
(561) 249-0278
Mailing address
PO BOX 639680, CINCINNATI, OH 45263-9680
(863) 688-1188
(863) 616-5846
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH26235
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006316300
—
FL
05
—
006316301
—
FL
01
—
2135692
PK
—
Enumeration date
06/21/2012
Last updated
12/03/2019
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