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

General Provider Information

NPI Number	:	1689456626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUBLIX SUPER MARKETS, INC.

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	:	863-616-5810

Provider Business Practice Location Address
First Line	:	4601 LINDSEY CROSSING
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32404-9325
Country	:	US
Telephone Number	:	850-772-6110
Fax Number	:	850-588-3004

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

Provider Enumeration Date	:	10/16/2023
Last Update Date	:	01/11/2024

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