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NPI Code Detail

MEDICARE: PUBLIX ALABAMA LLC

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
1332B00000XDurable Medical Equipment & Medical Supplies
2333600000XPharmacy
33336C0003XCommunity/Retail Pharmacy114433AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22148925OTHERPK

General Provider Information

NPI Number : 1407252992
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 : 205-608-4682
Fax Number : 205-386-4098
Provider Business Practice Location Address
First Line : 655 FIELDSTOWN RD
Second Line :
City : GARDENDALE
State : AL
Zip : 35071-2411
Country : US
Telephone Number : 205-608-4682
Fax Number : 205-386-4098
Authorized Official
Title or Position : VP PHARMACY
Name : DAIN RUSK
Credential :
Telephone Number : 863-688-1188
Provider Enumeration Date : 11/10/2014
Last Update Date : 01/03/2020

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