Organization
PUBLIX NORTH CAROLINA LP
Active
Other names
Publix Pharmacy #1619
Organization subpart
No
Provider details
NPI number
Authorized official
DAIN RUSK (VP PHARMACY)
(863) 688-1188
Entity
Organization
Contact information
Practice address
2765 NC HIGHWAY 210 E, HAMPSTEAD, NC 28443-8951
(910) 803-6010
(910) 550-1165
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
13741
NC
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2177502
PK
—
Enumeration date
03/27/2018
Last updated
01/03/2020
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