MEDICARE: PUBLIX PHARMACY #1433

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	333600000X	Pharmacy	2141338	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	1356783823	OTHER	FL	NPI
3	80-8012726187-6	OTHER	FL	CONSOLIDATED

General Provider Information

NPI Number	:	1285042739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUBLIX PHARMACY #1433

Provider Business Mailing Address
First Line	:	2438 LAUREL RD E
Second Line	:
City	:	NORTH VENICE
State	:	FL
Zip	:	34275-3204
Country	:	US
Telephone Number	:	941-488-2459
Fax Number	:

Provider Business Practice Location Address
First Line	:	2438 LAUREL RD E
Second Line	:
City	:	NORTH VENICE
State	:	FL
Zip	:	34275-3204
Country	:	US
Telephone Number	:	941-488-2459
Fax Number	:

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	PETE SENCHYSHAK
Credential	:	RPH
Telephone Number	:	941-705-8785

Provider Enumeration Date	:	07/29/2014
Last Update Date	:	07/29/2014

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