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NPI Code Detail

MEDICARE: PUBLIX SUPER MARKETS INC

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
1332B00000XDurable Medical Equipment & Medical Supplies
2333600000XPharmacy
33336C0003XCommunity/Retail PharmacyPHRE008815GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22015555OTHERPK

General Provider Information

NPI Number : 1265471205
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 : 930 NEW HOPE RD
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30045-6407
Country : US
Telephone Number : 770-682-2433
Fax Number : 770-682-2437
Authorized Official
Title or Position : VP PHARMACY
Name : DAIN RUSK
Credential :
Telephone Number : 863-688-1188
Provider Enumeration Date : 06/05/2006
Last Update Date : 01/03/2020

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