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
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1396394409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUBLIX SUPER MARKETS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 116181
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30368-6181
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3428 CLARK RD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34231-8406
Country	:	US
Telephone Number	:	941-554-0253
Fax Number	:	941-256-0713

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

Provider Enumeration Date	:	09/11/2019
Last Update Date	:	10/22/2019

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Directions to “PUBLIX SUPER MARKETS, INC. ” Practice Location

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