Publix Super Markets Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

PUBLIX SUPER MARKETS INC

Practice address

207 Russell Pkwy
Warner Robins, GA 31088-3251

Phone

(478) 329-5046

Fax

(478) 329-9789

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

Fred Ottolino, RPH

Title

VP of Pharmacy

Phone

(863) 688-1188

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• PUBLIX PHARMACY #0466 Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207872000000",
    "number": "1851331276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 RUSSELL PKWY",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310883251",
            "telephone_number": "478-329-5046",
            "fax_number": "478-329-9789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 RUSSELL PKWY",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310883251",
            "telephone_number": "478-329-5046",
            "fax_number": "478-329-9789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIX SUPER MARKETS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-07",
        "last_updated": "2008-04-11",
        "status": "A",
        "authorized_official_last_name": "OTTOLINO",
        "authorized_official_first_name": "FRED",
        "authorized_official_title_or_position": "VP OF PHARMACY",
        "authorized_official_telephone_number": "863-688-1188",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "GA",
            "license": "PHRE007694",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "1140019",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "1140019",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00587419A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PUBLIX PHARMACY #0466",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Christopher Pyle, LCSW

• Community/Retail Pharmacy in Warner Robins, GA
• Providers in Warner Robins, 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 Apr 11, 2008; 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.