Healthcare Provider Details

I. General information

NPI: 1033535570
Provider Name (Legal Business Name): PUBLIX NORTH CAROLINA LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2014
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 FINCHER FARM RD
MATTHEWS NC
28105-5462
US

IV. Provider business mailing address

PO BOX 639680
CINCINNATI OH
45263-9680
US

V. Phone/Fax

Practice location:
  • Phone: 704-814-6018
  • Fax: 704-321-8617
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 Number11887
License Number StateNC

VIII. Authorized Official

Name: CATHERINE E SCANLON
Title or Position: VP OF PHARMACY
Credential:
Phone: 863-688-1188