Organization
PUBLIX SUPER MARKETS INC
Active
Other names
Publix Pharmacy #1291
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
6015 WATSON BLVD, BYRON, GA 31008-6650
(478) 953-2615
(478) 845-2771
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
PHRE009713
GA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003106994A
—
GA
01
—
2127833
PK
—
Enumeration date
12/01/2010
Last updated
10/27/2022
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