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	PH0009965	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2008605	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306887898
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	:	4195 W LAKE MARY BLVD
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-2410
Country	:	US
Telephone Number	:	407-328-3062
Fax Number	:	407-328-3067

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	01/03/2020

Similar Medicare Providers

1912929530 — HOLIDAY CVS LLC
Practice Location Address:

4155 W LAKE MARY BLVD
LAKE MARY, FL
32746-2410

Practice Phone: 407-330-9190
Practice Fax: 407-547-3513

1477625978 — DR. ANGELA DENISE ADAMS PHARMD
Practice Location Address:

4155 W LAKE MARY BLVD
LAKE MARY, FL
32746-2410

Practice Phone: 407-330-9190
Practice Fax:

1861789497 — DR. ALEXANDRA CARTAYA TODD PHARMD
Practice Location Address:

4155 W LAKE MARY BLVD , TARGET 0845
LAKE MARY, FL
32746-2410

Practice Phone: 407-330-9190
Practice Fax: 407-330-9190

1316221203 — MR. DIPTESH AMIN
Practice Location Address:

4155 W LAKE MARY BLVD
LAKE MARY, FL
32746-2410

Practice Phone: 407-330-9190
Practice Fax: 407-330-9190

1164769022 — JINAL S PATEL PHARMACIST
Practice Location Address:

4195 W LAKE MARY BLVD
LAKE MARY, FL
32746-2410

Practice Phone: 407-328-3062
Practice Fax: 407-328-3068

1306183926 — STANFORD LEE FRIEDMAN RPH
Practice Location Address:

4195 W LAKE MARY BLVD
LAKE MARY, FL
32746-2410

Practice Phone: 407-328-3062
Practice Fax: 407-328-3067

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 © 2007-2026 (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.