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	PH0017172	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2013200	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902845951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUBLIX SUPER MARKETS INC

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	:	863-616-5810

Provider Business Practice Location Address
First Line	:	5032 CAPITAL CIR SW STE 1
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32305-7886
Country	:	US
Telephone Number	:	850-878-1740
Fax Number	:	850-878-2031

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	10/02/2025

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Directions to “PUBLIX SUPER MARKETS INC ” Practice Location

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