Provider Demographics
NPI:1477001352
Name:PUBLIX
Entity Type:Organization
Organization Name:PUBLIX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:SHAY
Authorized Official - Last Name:BARWICK
Authorized Official - Suffix:II
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:850-519-4385
Mailing Address - Street 1:4650 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-9419
Mailing Address - Country:US
Mailing Address - Phone:334-792-6824
Mailing Address - Fax:
Practice Address - Street 1:4650 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-9419
Practice Address - Country:US
Practice Address - Phone:334-792-6824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19487183500000X
FLPS55055183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty