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Provider Information for 1184665689


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PUBLIX SUPER MARKETS INC

Other Names:  
Doing Business As: 
PUBLIX PHARMACY #0620

Organization Subpart: NO

NPI: 1184665689
Last Updated: 2019-12-03
Certification Date:

Details

NameValue
NPI1184665689
Enumeration Date2006-06-08
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: DAIN RUSK
Title: VP Pharmacy
Phone: 8636881188
Mailing Address PO BOX 639680
CINCINNATI, OH 45263-9680
United States

Phone: 863-688-1188 | Fax:863-616-5846
 
Primary Practice Address 11977 SOUTHERN BLVD
ROYAL PALM BEACH, FL 33411-7619
United States

Phone: 561-792-2106 | Fax:561-792-2110
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDFL106233600
Other (non-Medicare)2011033PK
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 332B00000X - Durable Medical Equipment & Medical Supplies
No 333600000X - Pharmacy
Yes 3336C0003X - Pharmacy - Community/Retail PharmacyFLPH0015644