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General NPI Number Information
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NPI Number | 1356711089
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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 | 10/07/2015
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Last Update Date | 10/07/2015
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Provider Practice Location Address
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Address Line | 4065 HANCOCK BRIDGE PKWY
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City | FORT MYERS
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State | FL
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Zip | 33903-4294
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Country | US
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Telephone | 239-997-0212
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Fax |
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Provider Business Mailing Address
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Address Line | 4065 HANCOCK BRIDGE PKWY
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City | NORTH FORT MYERS
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State | FL
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Zip | 33903-4294
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DISTRICT MANAGER
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Name | MAGGIE KING
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Credential |
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Telephone | 239-206-7993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 1629017595
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License Number State | FL
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