NPIMap

Organization Active NPI

Publix North Carolina, LP

Doing business as Publix Pharmacy 1704

  • Community/Retail Pharmacy
  • Marvin, NC
National Provider Identifier
1033733175
Registry record updated Jul 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
PUBLIX NORTH CAROLINA, LP
Doing business as
Publix Pharmacy 1704
Practice address
1615 Providence Road South
Marvin, NC 28173
Phone
(704) 627-6266
Fax
(704) 837-4719
NPI assigned
Jun 4, 2020
Last updated
Jul 1, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Catherine E ScanlonNPI 1467797399
Title
VP of Pharmacy
Phone
(863) 688-1188

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

1615 Providence Road South
Marvin, NC 28173

Mailing address

PO Box 639680
Cincinnati, OH 45263-9680
Phone (863) 688-1188

Other names 1

  • Publix Pharmacy 1704 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20141103001228 TX Part B Supplier - Centralized Flu Biller 8123241858 This NPI is an additional NPI on the enrollment
Practice locations: Charlotte, NC
O20201119001350 NC DME Supplier - Pharmacy 8123241858 Practice locations: Marvin, NC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D2194543Publix Pharmacy #17041615 Providence Road South, Waxhaw, NC 28173Certificate of waiverSep 30, 2026

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Publix North Carolina, LP1615 Providence Rd S, Marvin, NC 28173-8314(704) 627-6266 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order) Accepts assignmentParticipating since Jan 1, 2015

National Provider Directory

National Provider Directory
Tax ID family
Publix North Carolina LP85 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 14

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 14

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782864000000",
    "number": "1033733175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 639680",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452639680",
            "telephone_number": "863-688-1188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 PROVIDENCE ROAD SOUTH",
            "city": "MARVIN",
            "state": "NC",
            "postal_code": "28173",
            "telephone_number": "704-627-6266",
            "fax_number": "704-837-4719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIX NORTH CAROLINA, LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-04",
        "last_updated": "2026-07-01",
        "certification_date": "2026-07-01",
        "status": "A",
        "authorized_official_last_name": "SCANLON",
        "authorized_official_first_name": "CATHERINE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "VP OF PHARMACY",
        "authorized_official_telephone_number": "863-688-1188"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Publix Pharmacy 1704",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Publix Pharmacy 1704",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marvin, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.