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	PH0022425	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	2007186	OTHER		PK

General Provider Information

NPI Number	:	1457455073
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	:	1005 NW 22ND AVE
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-8312
Country	:	US
Telephone Number	:	561-732-6802
Fax Number	:	561-732-6823

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

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	12/06/2019

Similar Medicare Providers

1154668283 — STEPHEN CHALHUB PHARM. D
Practice Location Address:

1005 NW 22ND AVE
BOYNTON BEACH, FL
33426-8312

Practice Phone: 561-732-6802
Practice Fax:

1992042857 — LOUIS BASSI
Practice Location Address:

1005 NW 22ND AVE
BOYNTON BEACH, FL
33426-8312

Practice Phone: 561-732-6802
Practice Fax: 561-732-6823

1770979304 — MR. JASON M MCCARTHY
Practice Location Address:

1005 GATEWAY BLVD
BOYNTON BEACH, FL
33426-8312

Practice Phone: 561-732-6148
Practice Fax:

1124004973 — DR. RAVI NAGARAJAN M.D.
Practice Location Address:

1900 N ATLANTIC AVE UNIT 1602
DAYTONA BEACH, FL
32118-8312

Practice Phone: 407-360-1742
Practice Fax: 321-339-1949

1891817029 — AKSHAYA BALAJI LLC
Practice Location Address:

1900 N ATLANTIC AVE UNIT 1602
DAYTONA BEACH, FL
32118-8312

Practice Phone: 407-285-5956
Practice Fax: 321-339-1949

1356120208 — KEVIN LLAVE DPT
Practice Location Address:

2954 PEBBLE BEACH CIR
FAIRFIELD, CA
94534-8312

Practice Phone: 707-685-6387
Practice Fax:

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 © 2007-2025 (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.