PUBLIX PHARMACY #1158 (PUBLIX SUPER MARKETS INC) NPI 1003037219

Pharmacy (Community/Retail Pharmacy) in Winter Garden, FL

NPI 1003037219 Organization Pharmacy Community/Retail Pharmacy Medicare Supplier Accepts Medicare Approved Payment CLIA Number 10D2088208 CLIA Certificate of Waiver

About PUBLIX PHARMACY #1158 (PUBLIX SUPER MARKETS INC)

Publix Pharmacy #1158 (publix Super Markets Inc) is a provider established in Winter Garden, Florida specializing in pharmacy (community/retail pharmacy) . The NPI number of Publix Pharmacy #1158 (publix Super Markets Inc) is 1003037219 and was assigned on May 2007. The practitioner's primary taxonomy code is 3336C0003X with license number PH22707 (FL). The provider is registered as an organization and their NPI record was last updated 2 years ago. The provider's is doing business as Publix Pharmacy #1158. The authorized official of this NPI record is Dain Rusk (Vp Pharmacy)

Publix Pharmacy #1158 is a medicare supplier with PTAN 0775140709 who accepts Medicare assignment for all durable medical equipment and supplies. The provider accepts the Medicare allowable as payment in full.The supplier carries the following product categories: Epoetin or Immunosuppressive Drugs or Infusion Drugs or Nebulizer Drugs or Oral Anticancer Drugs or Oral Antiemetic Drugs or Blood Glucose Monitors/Supplies (Non-Mail Order).

The CLIA number of Publix Pharmacy #1158 is 10D2088208 registered as a "pharmacy" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to Publix Pharmacy #1158 to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI

1003037219

Provider NamePUBLIX PHARMACY #1158 (PUBLIX SUPER MARKETS INC)
Provider Location Address15502 STONEYBROOK WEST PKWY STE 100 WINTER GARDEN, FL 34787
Provider Mailing AddressPO BOX 639680 CINCINNATI, OH 45263
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Other Organization NamePUBLIX PHARMACY #1158
Other Name TypeDoing Business As (3)
Enumeration Date05-02-2007
Last Update Date12-06-2019


Primary Taxonomy

Taxonomy Code3336C0003X
ClassificationPharmacy
TypeSuppliers
SpecializationCommunity/Retail Pharmacy
License No.PH22707
License StateFL
Taxonomy DescriptionA pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

Business Address

PUBLIX PHARMACY #1158
15502 STONEYBROOK WEST PKWY
STE 100
WINTER GARDEN, FL
ZIP 34787
Phone: (407) 654-6603
Fax: (407) 654-6650

Get Directions


Mailing Address

PUBLIX PHARMACY #1158
PO BOX 639680
CINCINNATI, OH
ZIP 45263
Phone: (863) 688-1188
Fax: (863) 616-5846



Authorized Official

Authorized Official Name DAIN RUSK
Authorized Official TitleVP PHARMACY
Authorized Official Phone(863) 688-1188

Medical Equipment Supplier

The provider carries the following medical supplies product categories:

PTAN0775140709
Accepts Medicare AssignmentYES
Specialities ListPharmacy.
Supplies List
  • Epoetin - Epoetin is a man-made version of human erythropoietin (EPO)
  • Immunosuppressive Drugs - Immunosuppressive drugs require dosage, frequency, and route of administration to prevent or treat the rejection of an organ transplant
  • Infusion Drugs -
  • Nebulizer Drugs - Albuterol, levalbuterol, and metaproterenol are all short-acting bronchodilators with beta-adrenergic stimulatory effect
  • Oral Anticancer Drugs - FDA anticancer drugs
  • Oral Antiemetic Drugs - FDA antiemetic drugs
  • Blood Glucose Monitors/Supplies (Non-Mail Order) - Home blood glucose monitors including lancets, reagent strips, and other supplies necessary for the proper functioning of the device
Competitive BiddingNO

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1003037219 is:

CLIA Number10D2088208
Facility TypePHARMACY
Certificate TypeCertificate of Waiver

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1332B00000XSuppliersDurable Medical Equipment & Medical SuppliesNo

Taxonomy Description: a supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

2333600000XSuppliersPharmacyNo

Taxonomy Description: a facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
2009109OTHER (01)
032076500MEDICAID (05)FL

Other Providers at the same location


The following 10 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1730202300DR. WENDI WARDLAW DDS
Individual
Dentist (General Practice)15502 STONEYBROOK WEST PKWY SUITE 126
WINTER GARDEN, FL 34787
(407) 380-7779
1346587151 AYAM SALEM
Individual
Pharmacist15502 STONEYBROOK WEST PKWY
WINTER GARDEN, FL 34787
(407) 654-6603
1033457486 KIMBERLY NGUYEN
Individual
Pharmacist15502 STONEYBROOK WEST PKWY
WINTER GARDEN, FL 34787
(407) 654-6603
1710972492 STACY A MCCONKEY MD
Individual
Pediatrics15502 STONEYBROOK WEST PKWY SUITE 2-108
WINTER GARDEN, FL 34787
(407) 656-0042
1457341414DR. HEATHER LEIGH ELIZONDO VEGA M.D.
Individual
Pediatrics (Adolescent Medicine)15502 STONEYBROOK WEST PKWY SUITE 2-108
WINTER GARDEN, FL 34787
(210) 287-7243
1760442321DR. ROBERT C DABROW MD
Individual
Pediatrics15502 STONEYBROOK WEST PKWY SUITE 112
WINTER GARDEN, FL 34787
(407) 656-0042
1558795179DR. WHITNEY MICHELLE MOORE PHARM.D.
Individual
Pharmacist15502 STONEYBROOK WEST PKWY SUITE 100
WINTER GARDEN, FL 34787
(407) 654-6603
1477808046ADVENTIST HEALTH SYSTEM SUNBELT INC
Organization
Pediatrics15502 STONEYBROOK WEST PKWY SUITE 2-108
WINTER GARDEN, FL 34787
(407) 656-0042
1801820493DR. CATHERINE LOE M.D.
Individual
Pediatrics15502 STONEYBROOK WEST PKWY SUITE 2-108
WINTER GARDEN, FL 34787
(407) 656-0042
1497264030 MICHELLE ELIZABETH RAMIREZ PHARMD
Individual
Pharmacist15502 STONEYBROOK WEST PKWY
WINTER GARDEN, FL 34787
(407) 654-6603

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.