MEDICARE: PUBLIX ALABAMA LLC

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
1	333600000X	Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	3336C0003X	Community/Retail Pharmacy	113790	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2131367	OTHER	PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134408339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUBLIX ALABAMA LLC

Provider Business Mailing Address
First Line	:	PO BOX 639680
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-9680
Country	:	US
Telephone Number	:	863-688-1188
Fax Number	:	863-616-5846

Provider Business Practice Location Address
First Line	:	2040 MARTIN ST S
Second Line	:
City	:	PELL CITY
State	:	AL
Zip	:	35128-2326
Country	:	US
Telephone Number	:	205-338-4081
Fax Number	:	205-814-6239

Authorized Official
Title or Position	:	VP PHARMACY
Name	:	DAIN RUSK
Credential	:
Telephone Number	:	863-688-1188

Provider Enumeration Date	:	08/05/2011
Last Update Date	:	02/28/2024

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Directions to “PUBLIX ALABAMA LLC ” Practice Location

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