Organization
PUBLIX NORTH CAROLINA LP
Active
Other names
Publix Pharmacy #1483
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
12810 S TRYON ST, CHARLOTTE, NC 28273-6949
(704) 587-0513
(704) 900-0625
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
12058
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801296983
—
NC
01
—
2147818
PK
—
05
—
7N2058
—
SC
05
—
DE3815
—
SC
Enumeration date
08/26/2014
Last updated
01/03/2020
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