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General NPI Number Information
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NPI Number | 1649410911
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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 | 02/26/2009
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Last Update Date | 03/21/2014
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Provider Practice Location Address
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Address Line | 3350 TAMIAMI TRL E
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City | NAPLES
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State | FL
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Zip | 34112-4912
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Country | US
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Telephone | 239-530-0375
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Fax | 239-530-0497
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Provider Business Mailing Address
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Address Line | PO BOX 116181
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City | ATLANTA
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State | GA
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Zip | 30368-6181
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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 | MANAGER OF MANAGED CARE
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Name | KATIE SCANLON
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PH23832
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License Number State | FL
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