Publix Super Markets Inc
Organization Active NPI Community/Retail Pharmacy · Dania Beach, FL
NPI 1790724664 · NPPES record last updated Jun 23, 2026
Key facts
- NPI
- 1790724664
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PH0018449 (FL)
- Legal business name
- PUBLIX SUPER MARKETS INC
- Practice address
- 402 E Dania Beach Blvd
Dania Beach, FL 33004-3040 - Phone
- (954) 920-7660
- Fax
- (954) 920-7011
- NPI assigned
- Jun 6, 2006
- Organization subpart
- No
Authorized official
- Name
- Catherine E Scanlon
- Title
- VP of Pharmacy
- Phone
- (863) 688-1188
Corporate family (same tax ID) 24
Practitioners 4
-
Bruce Stanley Black, R PH
-
Todd Rosen, PHARM.D.
-
Dorel Suboni, PHARM.D.
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Publix Pharmacy #0788 |
Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Blood Glucose Monitors/Supplies (Mail Order) | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070110000622 | TX | Part B Supplier - Centralized Flu Biller | 4385644673 |
This NPI is an additional NPI on the enrollment Practice locations: Lakeland, FL |
| O20100930083927 | FL | DME Supplier - Pharmacy | 4385644673 | Practice locations: Dania, FL |
National Provider Directory
- Tax ID family
- Publix Pharmacy 7413
Locations
402 E Dania Beach Blvd
Dania Beach, FL 33004
Phone (954) 920-7660
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
- HealthSun Health Plans Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | PH0018449 | FL | Yes |
Addresses
Primary practice location
402 E Dania Beach Blvd
Dania Beach, FL 33004-3040
Mailing address
PO Box 639680
Cincinnati, OH 45263-9680
Phone (863) 688-1188
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 025393600 | Medicaid | FL | |
| 2014517 | Other | PK |
Other names
- Publix Pharmacy #0788
NPI Registry JSON
{
"created_epoch": "1149552000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1782172800000",
"number": "1790724664",
"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",
"fax_number": "863-616-5846"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "402 E DANIA BEACH BLVD",
"city": "DANIA BEACH",
"state": "FL",
"postal_code": "330043040",
"telephone_number": "954-920-7660",
"fax_number": "954-920-7011"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PUBLIX SUPER MARKETS INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-06",
"last_updated": "2026-06-23",
"certification_date": "2026-06-23",
"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": "FL",
"license": "PH0018449",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "025393600",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2014517",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Publix Pharmacy #0788",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Publix Pharmacy #0788",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Dania Beach, FL
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- Alyssa Hillman Pinnock
- Shoshanna Ellen Poznanski
- Premium Mobility LLC
- Diana Marie Price
- Juan Carlos Quintana
- Mark Charles Rabiner
- Malika Rahaman
- Michelle-Ann Ramsay
- Cathie Hope Reicher
All providers in Dania Beach, FL · Community/Retail Pharmacy in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 23, 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.