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General NPI Number Information
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NPI Number | 1477001352
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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 | 09/20/2016
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Last Update Date | 09/20/2016
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Provider Practice Location Address
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Address Line | 4650 W MAIN ST
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City | DOTHAN
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State | AL
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Zip | 36305-9419
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Country | US
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Telephone | 334-792-6824
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Fax |
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Provider Business Mailing Address
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Address Line | 4650 W MAIN ST
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City | DOTHAN
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State | AL
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Zip | 36305-9419
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Country | US
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Telephone | 334-792-6824
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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. THOMAS SHAY BARWICK II
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Credential | PHARMD
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Telephone | 850-519-4385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS55055
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 19487
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License Number State | AL
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