Publix Super Markets Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

PUBLIX SUPER MARKETS INC

Practice address

5158 Memorial Dr
Stone Mountain, GA 30083-3111

Phone

(770) 297-5016

Fax

(404) 297-1801

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

Sarah Pope

Title

Contract Administrator

Phone

(863) 688-1188

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• PUBLIX PHARMACY #0535 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": "1191283200000",
    "number": "1942240379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5158 MEMORIAL DR",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300833111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5158 MEMORIAL DR",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300833111",
            "telephone_number": "770-297-5016",
            "fax_number": "404-297-1801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIX SUPER MARKETS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-07",
        "last_updated": "2007-10-02",
        "status": "A",
        "authorized_official_last_name": "POPE",
        "authorized_official_first_name": "SARAH",
        "authorized_official_title_or_position": "CONTRACT ADMINISTRATOR",
        "authorized_official_telephone_number": "863-688-1188"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "GA",
            "license": "PHRE007890",
            "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": "1141807",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00673296A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PUBLIX PHARMACY #0535",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Stone Mountain, GA
• Providers in Stone Mountain, 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 Oct 2, 2007; 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.