Healthcare Provider Details

I. General information

NPI: 1043698517
Provider Name (Legal Business Name): PUBLIX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 HIGHWAY A1A # 4B
SATELLITE BEACH FL
32937-2342
US

IV. Provider business mailing address

1024 HIGHWAY A1A
SATELLITE BEACH FL
32937-2342
US

V. Phone/Fax

Practice location:
  • Phone: 321-773-7035
  • Fax:
Mailing address:
  • Phone: 321-773-7035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MS. DAWN GOODWIN
Title or Position: PHARMACIST
Credential: RPH
Phone: 321-773-7035