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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
1333600000XPharmacyPH0014380FL
23336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11079575OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1245270628
Entity Type Code : Organization
Provider Name (Legal Business Name) : PUBLIX SUPER MARKETS INC
Provider Business Mailing Address
First Line : 501 SE 18TH AVE
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33435-6949
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 501 SE 18TH AVE
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33435-6949
Country : US
Telephone Number : 561-738-5590
Fax Number : 561-733-4609
Authorized Official
Title or Position : CONTRACT ADMINISTRATOR
Name : SARAH POPE
Credential :
Telephone Number : 863-688-1188
Provider Enumeration Date : 06/07/2006
Last Update Date : 11/23/2007

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1750783478 — CHARLOTTE MARIE LOPEZ PHARM.D.
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2940 N LYNNHAVEN RD , SUITE 130
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Directions to “PUBLIX SUPER MARKETS INC ” Practice Location

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