Organization
PUBLIX TENNESSEE LLC
Active
Other names
Publix Pharmacy #1244
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
5958 SNOW HILL RD STE 168, OOLTEWAH, TN 37363-7834
(423) 238-2105
(423) 910-3001
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
4584
TN
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2117892
PK
—
Enumeration date
11/18/2008
Last updated
02/28/2024
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