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	PH0021623	FL

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	2005292	OTHER		PK

General Provider Information

NPI Number	:	1013957323
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	:	1951 S NARCOOSSEE RD
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34771-7211
Country	:	US
Telephone Number	:	407-892-2060
Fax Number	:	407-892-2064

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	:	12/06/2019

Similar Medicare Providers

1295468262 — KATIUSKA BORGES ALFONSO MD
Practice Location Address:

1931 S NARCOOSSEE RD
SAINT CLOUD, FL
34771-7211

Practice Phone: 407-986-9642
Practice Fax: 833-450-5421

1467424143 — DR. LUIS RAFAEL ALVARADO LOPEZ M.D.
Practice Location Address:

1931 S NARCOOSSEE RD
SAINT CLOUD, FL
34771-7211

Practice Phone: 407-986-9642
Practice Fax: 833-450-5421

1538355060 — DR. GLENDA MARIE NIEVES PEREZ M.D.
Practice Location Address:

1931 S NARCOOSSEE RD
SAINT CLOUD, FL
34771-7211

Practice Phone: 407-986-9642
Practice Fax: 407-593-6102

1669777264 — ST CLOUD PHYSICIAN MANAGEMENT LLC
Practice Location Address:

1931 S NARCOOSSEE RD
SAINT CLOUD, FL
34771-7211

Practice Phone: 407-891-0045
Practice Fax:

1720325897 — CRISTINA ALVAREZ-CORREA PHARMD
Practice Location Address:

1951 S NARCOOSSEE RD
SAINT CLOUD, FL
34771-7211

Practice Phone: 407-892-2060
Practice Fax:

1790022630 — SUNIL S DESAI RPH
Practice Location Address:

1951 S NARCOOSSEE RD
SAINT CLOUD, FL
34771-7211

Practice Phone: 407-892-2060
Practice Fax:

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.