Publix Super Markets Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHRE007931 Issued in GA

Legal business name

PUBLIX SUPER MARKETS INC

Doing business as

Publix Pharmacy #0545

Practice address

11155 Tara Blvd
Hampton, GA 30228-1672

Phone

(770) 473-6886

Fax

(770) 473-4716

NPI assigned

Jun 7, 2006

Organization subpart

No

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

Authorized official

Name

Jacqueline Rusch

Title

Manager of Managed Care

Phone

(863) 688-1188

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Publix Pharmacy #0545 Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robert Haynes, RPH

  • Pharmacist
  • Hampton, GA
  • NPI 1952649014
  NPD (past)
• Regina Jacobs Warner, PHARMD

  • Pharmacist
  • Hampton, GA
  • NPI 1922346410
  NPD (past)

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438646400000",
    "number": "1225078645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 116181",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303686181",
            "telephone_number": "863-688-1188",
            "fax_number": "863-616-5846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11155 TARA BLVD",
            "city": "HAMPTON",
            "state": "GA",
            "postal_code": "302281672",
            "telephone_number": "770-473-6886",
            "fax_number": "770-473-4716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIX SUPER MARKETS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-07",
        "last_updated": "2015-08-04",
        "status": "A",
        "authorized_official_last_name": "RUSCH",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_title_or_position": "MANAGER OF MANAGED CARE",
        "authorized_official_telephone_number": "863-688-1188"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "PHRE007931",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00685748A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2019234",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Publix Pharmacy #0545",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Premium Care Health, LLC
• Prestigious Therapy Consulting Services
• Primecare RN Services LLC
• Proud Life Home Care LLC
• Molli Ashmore Pruitt, LPC, NCC
• Publix Super Markets, Inc.
• Rachel'S Angels
• T Randall, CCM
• Lynda Rappold
• Keisha N Ray, BC-TMH, LMSW

• Community/Retail Pharmacy in Hampton, GA
• Providers in Hampton, GA by specialty
• Community/Retail Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.