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General NPI Number Information
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NPI Number | 1154719078
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Entity Type | Organization
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Legal Business Name | PUBLIX
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Dates
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Enumeration Date | 12/30/2014
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Last Update Date | 12/30/2014
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Provider Practice Location Address
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Address Line | 27615 US HIGHWAY 27
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City | LEESBURG
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State | FL
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Zip | 34748-9396
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Country | US
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Telephone | 352-787-2122
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Fax |
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Provider Business Mailing Address
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Address Line | 8657 VISTA DEL BOCA DR
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City | BOCA RATON
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State | FL
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Zip | 33433-2528
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Country | US
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Telephone | 561-866-7248
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | DR. ALLISON MANLULU MEGANO
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Credential | PHARMD
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Telephone | 561-866-7248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | PS52607
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License Number State | FL
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