Healthcare Provider Details

I. General information

NPI: 1366890964
Provider Name (Legal Business Name): PUBLIX NORTH CAROLINA LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2016
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 BRAWLEY SCHOOL RD
MOORESVILLE NC
28117-6204
US

IV. Provider business mailing address

PO BOX 639680
CINCINNATI OH
45263-9680
US

V. Phone/Fax

Practice location:
  • Phone: 704-660-6807
  • Fax: 704-360-5908
Mailing address:
  • Phone: 863-688-1188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number13014
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

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