NPIMap

Organization Active NPI

Publix North Carolina, LP

Doing business as Publix Pharmacy #1858

  • Community/Retail Pharmacy
  • Winston Salem, NC
National Provider Identifier
1194403329
Registry record updated Sep 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
PUBLIX NORTH CAROLINA, LP
Doing business as
Publix Pharmacy #1858
Practice address
5525 Robin Lark Circle
Winston-Salem, NC 27106
Phone
(336) 815-6008
Fax
(336) 793-9973
NPI assigned
Jul 7, 2023
Last updated
Sep 29, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dain Rusk
Title
VP of Pharmacy
Phone
(863) 688-1188

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

5525 Robin Lark Circle
Winston-Salem, NC 27106

Mailing address

PO Box 639680
Cincinnati, OH 45263-9680
Phone (863) 688-1188

Other names 1

  • Publix Pharmacy #1858 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20141103001228 TX Part B Supplier - Centralized Flu Biller 8123241858 This NPI is an additional NPI on the enrollment
Practice locations: Charlotte, NC
O20240607000026 NC DME Supplier - Pharmacy 8123241858 Practice locations: Winston-Salem, NC

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Publix North Carolina, LP5525 Robin Lark Circle, Winston-Salem, NC 27106-9906(336) 815-6008 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order) Accepts assignmentParticipating since Jan 1, 2015

National Provider Directory

National Provider Directory
Tax ID family
Publix North Carolina LP85 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 21

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 21

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

5525 Robin Lark Cir
Winston Salem, NC 27106
Phone (336) 815-6008

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1688688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695945600000",
    "number": "1194403329",
    "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": "863-616-5810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5525 ROBIN LARK CIRCLE",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "27106",
            "telephone_number": "336-815-6008",
            "fax_number": "336-793-9973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUBLIX NORTH CAROLINA, LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-07",
        "last_updated": "2023-09-29",
        "certification_date": "2023-09-29",
        "status": "A",
        "authorized_official_last_name": "RUSK",
        "authorized_official_first_name": "DAIN",
        "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": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Publix Pharmacy #1858",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Publix Pharmacy #1858",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.