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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
1333600000XPharmacyPH29414FL
2332B00000XDurable Medical Equipment & Medical Supplies
33336C0002XClinic Pharmacy
43336C0003XCommunity/Retail Pharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
32154386OTHERPK

General Provider Information

NPI Number : 1730558586
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 : 863-616-5846
Provider Business Practice Location Address
First Line : 10920 MCKINLEY DR STE 11.1114
Second Line :
City : TAMPA
State : FL
Zip : 33612-6471
Country : US
Telephone Number : 863-688-1188
Fax Number :
Authorized Official
Title or Position : VP PHARMACY
Name : DAIN RUSK
Credential :
Telephone Number : 863-688-1188
Provider Enumeration Date : 09/23/2015
Last Update Date : 10/15/2020

Similar Medicare Providers

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1467841577 — GINA CORSANICO ARNP
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1730617531 — KATHLEEN CUNNINGHAM PERMENTER PA-C
Practice Location Address:
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Directions to “PUBLIX SUPER MARKETS INC ” Practice Location

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