Organization
PUBLIX SUPER MARKETS INC
Active
Other names
PUBLIX PHARMACY #0535
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH POPE (CONTRACT ADMINISTRATOR)
(863) 688-1188
Entity
Organization
Contact information
Practice address
5158 MEMORIAL DR, STONE MOUNTAIN, GA 30083-3111
(770) 297-5016
(404) 297-1801
Mailing address
5158 MEMORIAL DR, STONE MOUNTAIN, GA 30083-3111
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PHRE007890
GA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00673296A
—
GA
01
—
1141807
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
06/07/2006
Last updated
10/02/2007
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