MEDICARE: PUBLIX SUPER MARKETS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	50004511	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2091576	OTHER		PK

General Provider Information

NPI Number	:	1003856444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUBLIX SUPER MARKETS INC

Provider Business Mailing Address
First Line	:	PO BOX 639680
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-9680
Country	:	US
Telephone Number	:	863-688-1188
Fax Number	:	863-616-5846

Provider Business Practice Location Address
First Line	:	150 HARBISON BLVD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-2204
Country	:	US
Telephone Number	:	803-407-0923
Fax Number	:	803-407-9118

Authorized Official
Title or Position	:	VP PHARMACY
Name	:	DAIN RUSK
Credential	:
Telephone Number	:	863-688-1188

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	11/18/2019

Similar Medicare Providers

1184629842 — DR. WILLIAM LYNN CAMPBELL DMD
Practice Location Address:

124 HARBISON BLVD
COLUMBIA, SC
29212-2204

Practice Phone: 803-732-0900
Practice Fax: 803-732-0990

1972525616 — SOUTH CAROLINA CVS PHARMACY LLC
Practice Location Address:

134 HARBISON BLVD
COLUMBIA, SC
29212-2204

Practice Phone: 803-407-0328
Practice Fax: 803-740-2542

1659437788 — W LYNN CAMPBELL DMD. PA.
Practice Location Address:

124 HARBISON BLVD
COLUMBIA, SC
29212-2204

Practice Phone: 803-732-0900
Practice Fax: 803-732-0990

1538453691 — MARY GRACE JOHNSON PHARMD
Practice Location Address:

134 HARBISON BLVD , T1199
COLUMBIA, SC
29212-2204

Practice Phone: 803-407-0328
Practice Fax: 803-407-0328

1043505621 — SARAH N WILHELM PHARM.D.
Practice Location Address:

134 HARBISON BLVD
COLUMBIA, SC
29212-2204

Practice Phone: 803-407-0328
Practice Fax: 803-407-0328

1043556970 — LILLIAN DENISE HILL RPH
Practice Location Address:

150 HARBISON BLVD
COLUMBIA, SC
29212-2204

Practice Phone: 803-407-0923
Practice Fax: 803-407-9118

Directions to “PUBLIX SUPER MARKETS INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.