Organization
PUBLIX SUPER MARKETS INC
Active
Other names
Publix Pharmacy #1004
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
7310 MANATEE AVE W, BRADENTON, FL 34209-3441
(941) 792-6295
(941) 795-0520
Mailing address
PO BOX 639680, CINCINNATI, OH 45263-9680
(863) 688-1188
(863) 616-5846
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH0021013
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
028437800
—
FL
05
—
028437801
—
FL
01
—
2003977
PK
—
Enumeration date
06/07/2006
Last updated
12/06/2019
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