Provider Type Icon

PUBLIX SUPER MARKETS INC NPI 1215976089


NPI Information

NPI: 1215976089
Provider Name: PUBLIX SUPER MARKETS INC

Doing Business As: PUBLIX PHARMACY #0766

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

CLIA Number: 10D2088865

Address:
251 MIRACLE STRIP PKWY SE
FORT WALTON BEACH, FL
ZIP 32548
Phone: (850) 796-1937
Get Directions

PUBLIX SUPER MARKETS INC is a community/retail pharmacy pharmacy in Fort Walton Beach, FL. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. PUBLIX SUPER MARKETS INC NPI is 1215976089. The provider is registered as an organization entity type.
The provider Is Doing Business As Publix Pharmacy #0766.

The provider's business location address is:

251 MIRACLE STRIP PKWY SE
FORT WALTON BEACH, FL
ZIP 32548-853
Phone: (850) 796-1937
Fax: (850) 796-1950

The provider's authorized official is Dain Rusk .
The authorized official title is Vp Pharmacy and has the following contact phone number (863) 688-1188.

The CLIA number assigned to this NPI record is 10D2088865 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/6/2006 and was last updated on 12/6/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1332B00000XDurable Medical Equipment & Medical SuppliesNo
2333600000XPharmacyNo
33336C0003XPharmacyCommunity/Retail PharmacyPH0017936FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1022825700MEDICAIDFLORIDA
22013926OTHERPK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.