Organization
PUBLIX SUPER MARKETS, INC.
Active
Other names
Publix Pharmacy #1628
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
3501 49TH ST N, SAINT PETERSBURG, FL 33710-2149
(727) 318-6869
(727) 897-5601
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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2178095
PK
—
Enumeration date
06/06/2018
Last updated
12/02/2019
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