Publix North Carolina, LP
Organization Active NPI Community/Retail Pharmacy · Marvin, NC
NPI 1033733175 · NPPES record last updated Jul 1, 2026
Key facts
- NPI
- 1033733175
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- PUBLIX NORTH CAROLINA, LP
- Practice address
- 1615 Providence Road South
Marvin, NC 28173 - Phone
- (704) 627-6266
- Fax
- (704) 837-4719
- NPI assigned
- Jun 4, 2020
- Organization subpart
- No
Authorized official
- Name
- Catherine E Scanlon
- Title
- VP of Pharmacy
- Phone
- (863) 688-1188
Corporate family (same tax ID) 14
Member of 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 34D2194543 | Publix Pharmacy #1704 | Certificate of waiver | Sep 30, 2026 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Publix North Carolina, LP |
Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order) | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Publix North Carolina LP
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | Yes |
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
- Publix Pharmacy 1704
Other providers in Marvin, NC
- Vinutha Kupperi
- Loving Care Solutions LLC
- Kerry Roberts Poe
- Madison Dawn Poor
- Porters Health Services LLC
- Marian Nabil Riwes
- Chandler Page Thomas
- Wood Healthcare PLLC
- Zackery Shane Wood
All providers in Marvin, NC · Community/Retail Pharmacy in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 1, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.