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	PH22866	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	2009499	OTHER		PK

General Provider Information

NPI Number	:	1831397447
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	:	1075 OAKLEAF PLANTATION PKWY
Second Line	:	STE 200
City	:	ORANGE PARK
State	:	FL
Zip	:	32065-3624
Country	:	US
Telephone Number	:	904-291-5203
Fax Number	:	904-291-5651

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

Provider Enumeration Date	:	07/05/2007
Last Update Date	:	12/06/2019

Similar Medicare Providers

1174798433 — ORANGE COUNTY NEWBORN MEDICARE CARE PC
Practice Location Address:

3 SAINT STEPHENS PL , SUITE 2
WARWICK, NY
10990-3208

Practice Phone: 845-987-9700
Practice Fax:

1093913212 — ALLISON DASTA BUTLER M.D.
Practice Location Address:

1075 OAKLEAF PLANTATION PKWY , SUITE #108
ORANGE PARK, FL
32065-3624

Practice Phone: 904-282-4565
Practice Fax: 904-282-4225

1942481429 — FAMILY FIRST PRIMARY CARE PA
Practice Location Address:

1075 OAKLEAF PLANTATION PKWY , SUITE 108
ORANGE PARK, FL
32065-3624

Practice Phone: 904-282-4565
Practice Fax: 904-282-4225

1649517657 — TERESA MARIE PONDER PHARM D
Practice Location Address:

1075 OAKLEAF PLANTATION PKWY , STE 200
ORANGE PARK, FL
32065-3624

Practice Phone: 904-291-5203
Practice Fax: 904-291-5651

1740658954 — TIFFANY MCCLAIN
Practice Location Address:

1075 OAKLEAF PLANTATION PKWY , STE 108
ORANGE PARK, FL
32065-3624

Practice Phone: 904-282-4565
Practice Fax:

1306399126 — LAELISHA PATTON ARNP
Practice Location Address:

1075 OAKLEAF PLANTATION PKWY , #108
ORANGE PARK, FL
32065-3624

Practice Phone: 904-282-4565
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 © 2007-2026 (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.