Organization
PUBLIX SUPER MARKETS INC
Active
Other names
Publix Pharmacy #2100
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP OF PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
1311 FORK SHOALS RD, MAULDIN, SC 29605
(864) 248-1293
(864) 551-2119
Mailing address
PO BOX 407, LAKELAND, FL 33802-0407
(863) 688-1188
(863) 616-5810
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
03/06/2025
Last updated
11/03/2025
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