| NPI | 1164461075 |
|---|---|
| Doing Business As | PUBLIX PHARMACY #1179 |
| Entity Type | Organization |
| Authorized Contact | DAIN RUSK VP Pharmacy 863-688-1188 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: FL PH0010705) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2019-12-06 |