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Organization

PUBLIX SUPER MARKETS INC

Active
Other names
Publix Pharmacy #1406
Organization subpart
No

Provider details

NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization

Contact information

Practice address
463855 STATE ROAD 200, YULEE, FL 32097-3639
(904) 261-2405
(904) 261-2410
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
PH26006
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
004789900
FL
05
004789901
FL
01
2134071
PK
Enumeration date
03/05/2012
Last updated
12/03/2019
About Stedi
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