Healthcare Provider Details

I. General information

NPI: 1760426498
Provider Name (Legal Business Name): PUBLIX SUPER MARKETS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 EAU GALLIE BLVD
SATELLITE BEACH FL
32937
US

IV. Provider business mailing address

243 EAU GALLIE BLVD
SATELLITE BEACH FL
32937
US

V. Phone/Fax

Practice location:
  • Phone: 321-773-9729
  • Fax: 321-773-9791
Mailing address:
  • Phone: 321-773-9729
  • Fax: 321-773-9791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH0016124
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SARAH POPE
Title or Position: CONTRACT ADMINISTRATOR
Credential:
Phone: 863-688-1188