Organization
PUBLIX SUPER MARKETS, INC.
Active
Other names
Publix Pharmacy #1468
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
2771 MONUMENT RD STE 19, JACKSONVILLE, FL 32225-3547
(904) 641-1451
(904) 641-5314
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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH28651
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014495600
—
FL
05
—
014495601
—
FL
01
—
2006230
PK
—
Enumeration date
06/07/2006
Last updated
12/03/2019
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