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
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy	13386	NC
3	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2171899	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457872137
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	:

Provider Business Practice Location Address
First Line	:	3150 GAMMON LN
Second Line	:
City	:	CLEMMONS
State	:	NC
Zip	:	27012-9052
Country	:	US
Telephone Number	:	336-293-9704
Fax Number	:	336-793-4468

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

Provider Enumeration Date	:	07/03/2017
Last Update Date	:	01/03/2020

Similar Medicare Providers

1992019566 — MRS. ANDREA DAWN STOKES UNDERWOOD DNP, FNP-C
Practice Location Address:

3163 GAMMON LN
CLEMMONS, NC
27012-9052

Practice Phone: 336-310-5571
Practice Fax: 336-310-5574

1699178731 — JACOB GRAY LACKEY PA-C
Practice Location Address:

3163 GAMMON LN
CLEMMONS, NC
27012-9052

Practice Phone: 336-310-5571
Practice Fax: 336-310-5574

1659920627 — CHELSEA LAM PHARMD
Practice Location Address:

3150 GAMMON LN
CLEMMONS, NC
27012-9052

Practice Phone: 336-293-9704
Practice Fax:

1134737265 — DR. JOSHUA FLEMING DNP-FNP
Practice Location Address:

3163 GAMMON LN
CLEMMONS, NC
27012-9052

Practice Phone: 336-310-5571
Practice Fax:

1639836562 — DR. DANIELLE SHERIE WALKER PHARM.D.
Practice Location Address:

3150 GAMMON LN
CLEMMONS, NC
27012-9052

Practice Phone: 336-766-2069
Practice Fax:

1952268278 — STEPHANIE MARIE JASSO
Practice Location Address:

6915 VILLAGE MEDICAL CIR
CLEMMONS, NC
27012-8002

Practice Phone: 336-893-1000
Practice Fax:

Directions to “PUBLIX NORTH CAROLINA LP ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.