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General NPI Number Information
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NPI Number | 1649210089
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Entity Type | Organization
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Legal Business Name | PUBLIX SUPER MARKETS INC
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 11/18/2019
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Provider Practice Location Address
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Address Line | 8409 DORCHESTER RD STE 104
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City | NORTH CHARLESTON
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State | SC
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Zip | 29420-7324
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Country | US
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Telephone | 843-767-5976
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Fax | 843-767-5979
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Provider Business Mailing Address
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Address Line | PO BOX 639680
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City | CINCINNATI
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State | OH
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Zip | 45263-9680
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Country | US
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Telephone | 863-688-1188
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Fax | 863-616-5846
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Authorized Official
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Title or Position | VP PHARMACY
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Name | DAIN RUSK
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Credential |
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Telephone | 863-688-1188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 50006389
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License Number State | SC
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