MEDICARE: PUBLIX ALABAMA, LLC

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	:	1447894175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUBLIX ALABAMA, LLC

Provider Business Mailing Address
First Line	:	PO BOX 407
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33802-0407
Country	:	US
Telephone Number	:	863-688-1188
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 ENDEAVOR LANE
Second Line	:
City	:	VESTAVIA HILLS
State	:	AL
Zip	:	35242
Country	:	US
Telephone Number	:	205-967-5338
Fax Number	:	205-421-2983

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

Provider Enumeration Date	:	11/06/2019
Last Update Date	:	03/23/2020

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