Provider Demographics
NPI:1457727950
Name:PUBLIX STORE #1339
Entity type:Organization
Organization Name:PUBLIX STORE #1339
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FLOATER PHAR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-996-2966
Mailing Address - Street 1:4950 BELLE TERRE PKWY
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8692
Mailing Address - Country:US
Mailing Address - Phone:434-996-2666
Mailing Address - Fax:
Practice Address - Street 1:4950 BELLE TERRE PKWY
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8692
Practice Address - Country:US
Practice Address - Phone:434-996-2666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL53068183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty