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NPI Code Detail

MEDICARE: PUBLIX SUPER MARKETS, INC

MEDICARE: PUBLIX SUPER MARKETS, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy
23336C0003XCommunity/Retail Pharmacy

General Provider Information

NPI Number : 1013052117
Entity Type Code : Organization
Provider Name (Legal Business Name) : PUBLIX SUPER MARKETS, INC
Provider Business Mailing Address
First Line : 3300 PUBLIX CORPORATE PKWY
Second Line :
City : LAKELAND
State : FL
Zip : 33811-3311
Country : US
Telephone Number : 863-688-1188
Fax Number : 863-616-5845
Provider Business Practice Location Address
First Line : 3300 PUBLIX CORPORATE PKWY
Second Line :
City : LAKELAND
State : FL
Zip : 33811-3311
Country : US
Telephone Number : 863-688-1188
Fax Number : 863-616-5845
Authorized Official
Title or Position : VP PHARMACY
Name : DAIN RUSK
Credential :
Telephone Number : 863-688-1188
Provider Enumeration Date : 02/20/2007
Last Update Date : 01/03/2020

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