Healthcare Provider Details

I. General information

NPI: 1134408339
Provider Name (Legal Business Name): PUBLIX ALABAMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 MARTIN ST S
PELL CITY AL
35128-2326
US

IV. Provider business mailing address

PO BOX 639680
CINCINNATI OH
45263-9680
US

V. Phone/Fax

Practice location:
  • Phone: 205-338-4081
  • Fax: 205-814-6239
Mailing address:
  • Phone: 863-688-1188
  • Fax: 863-616-5846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number113790
License Number StateAL

VIII. Authorized Official

Name: DAIN RUSK
Title or Position: VP PHARMACY
Credential:
Phone: 863-688-1188