Healthcare Provider Details

I. General information

NPI: 1588529788
Provider Name (Legal Business Name): PUBLIX SUPER MARKETS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12535 NORTHLAKE BLVD
PALM BEACH GARDENS FL
33412-2757
US

IV. Provider business mailing address

PO BOX 407
LAKELAND FL
33802-0407
US

V. Phone/Fax

Practice location:
  • Phone: 561-530-5849
  • Fax: 561-249-4036
Mailing address:
  • Phone: 863-688-1188
  • Fax: 863-616-5810

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 Number
License Number State

VIII. Authorized Official

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