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General NPI Number Information
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NPI Number | 1629440862
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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 | 10/27/2015
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Last Update Date | 10/27/2015
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Provider Practice Location Address
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Address Line | 309 RIDGEWAY DR
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City | ENTERPRISE
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State | AL
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Zip | 36330-1636
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Country | US
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Telephone | 334-803-4359
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Fax |
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Provider Business Mailing Address
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Address Line | 309 RIDGEWAY DR
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City | ENTERPRISE
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State | AL
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Zip | 36330-1636
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Country | US
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Telephone | 334-803-4359
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | MRS. KHADIJA F CALDWELL
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Credential | PHARMD
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Telephone | 334-673-1215
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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 | 113406
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License Number State | AL
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