Organization
PUBLIX SUPER MARKETS, INC.
Active
Other names
Publix Pharmacy #1437
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
220 FRONT ST, PONTE VEDRA BEACH, FL 32082-5022
(904) 280-5441
(904) 567-8596
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
PH27135
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010034900
—
FL
05
—
010034901
—
FL
01
—
2142343
PK
—
Enumeration date
09/30/2013
Last updated
11/15/2019
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