MEDICARE: PUBLIX TENNESSEE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1629768957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUBLIX TENNESSEE, LLC

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

Provider Business Practice Location Address
First Line	:	1688 OOLTEWAH RINGGOLD RD, SUITE 100
Second Line	:
City	:	OOLTEWAH
State	:	TN
Zip	:	37363
Country	:	US
Telephone Number	:	423-508-6835
Fax Number	:	423-443-4425

Authorized Official
Title or Position	:	VP PHARMACY
Name	:	CATHERINE E SCANLON
Credential	:
Telephone Number	:	863-688-1188

Provider Enumeration Date	:	05/10/2023
Last Update Date	:	06/25/2026

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Directions to “PUBLIX TENNESSEE, LLC ” Practice Location

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