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NPI Code Detail

MEDICARE: PUBLIX NORTH CAROLINA LP

MEDICARE: PUBLIX NORTH CAROLINA LP
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
1332B00000XDurable Medical Equipment & Medical Supplies
2333600000XPharmacy13087NC
33336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12167163OTHERPK

General Provider Information

NPI Number : 1134679517
Entity Type Code : Organization
Provider Name (Legal Business Name) : PUBLIX NORTH CAROLINA LP
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 : 1441 KELLY RD
Second Line :
City : APEX
State : NC
Zip : 27502-9572
Country : US
Telephone Number : 919-303-6204
Fax Number :
Authorized Official
Title or Position : VP PHARMACY
Name : DAIN RUSK
Credential :
Telephone Number : 863-688-1188
Provider Enumeration Date : 10/10/2016
Last Update Date : 01/03/2020

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Directions to “PUBLIX NORTH CAROLINA LP ” Practice Location

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