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General NPI Number Information
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NPI Number | 1245600055
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Entity Type | Organization
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Legal Business Name | PUBLIX PHARMACY
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Dates
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Enumeration Date | 10/06/2015
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Last Update Date | 10/06/2015
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Provider Practice Location Address
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Address Line | 7290 55TH AVE E
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City | BRADENTON
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State | FL
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Zip | 34203-8002
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Country | US
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Telephone | 941-727-8808
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Fax |
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Provider Business Mailing Address
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Address Line | 7290 55TH AVE E
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City | BRADENTON
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State | FL
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Zip | 34203-8002
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Country | US
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Telephone | 941-727-8808
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Fax |
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Authorized Official
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Title or Position | DISTRICT SUPERVISOR
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Name | JOHN KUSHNER
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Credential |
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Telephone | 941-626-0476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | PS54097
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License Number State | FL
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