Organization
PUBLIX SUPER MARKETS INC
Active
Other names
Publix Pharmacy #1537
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
1430 TIGER PARK LN, GULF BREEZE, FL 32563-5718
(850) 203-6469
(850) 677-3588
Mailing address
PO BOX 639680, CINCINNATI, OH 45263-9680
(863) 688-1188
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
PH31112
FL
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2174800
PK
—
Enumeration date
10/26/2017
Last updated
12/03/2019
About Stedi
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