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Provider Information for 1871895581


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PUBLIX SUPER MARKETS INC

Other Names:  
Doing Business As: 
PUBLIX PHARMACY #1291

Organization Subpart: NO

NPI: 1871895581
Last Updated: 2022-10-27
Certification Date: 2022-10-27

Details

NameValue
NPI1871895581
Enumeration Date2010-12-01
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 6015 WATSON BLVD
BYRON, GA 31008-6650
United States

Phone: 478-953-2615 | Fax:478-845-2771
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDGA003106994A
Other (non-Medicare)2127833PK
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 332B00000X - Durable Medical Equipment & Medical Supplies
No 333600000X - Pharmacy GAPHRE009713
Yes 3336C0003X - Pharmacy - Community/Retail Pharmacy