Organization
PUBLIX SUPER MARKETS INC
Active
Other names
PUBLIX PHARMACY #0466
Organization subpart
No
Provider details
NPI number
Authorized official
FRED OTTOLINO RPH (VP OF PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
207 RUSSELL PKWY, WARNER ROBINS, GA 31088-3251
(478) 329-5046
(478) 329-9789
Mailing address
207 RUSSELL PKWY, WARNER ROBINS, GA 31088-3251
(478) 329-5046
(478) 329-9789
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PHRE007694
GA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00587419A
—
GA
01
—
1140019
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
06/07/2006
Last updated
04/11/2008
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