Organization
PUBLIX SUPER MARKETS INC
Active
Other names
Publix Pharmacy #1169
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
1075 OAKLEAF PLANTATION PKWY, STE 200, ORANGE PARK, FL 32065-3624
(904) 291-5203
(904) 291-5651
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
PH22866
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
032157500
—
FL
01
—
2009499
PK
—
Enumeration date
07/05/2007
Last updated
12/06/2019
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