Publix Pharmacy #0779 – Community/Retail Pharmacy, NPI 1619916582

Publix Pharmacy #0779 is a healthcare provider. based in Cincinnati, Ohio. specializing in Community/Retail Pharmacy. The organization holds a License No. PH0017925 (FL). The NPI Number for Publix Pharmacy #0779 is 1619916582

Main info

Organization
Name
Publix Pharmacy #0779
NPI
1619916582
Phone
(863) 688-1188
Address
PO BOX 639680
Authorized Official
DAIN RUSK VP PHARMACY
Enumeration Date
6 June 2006
Last Update Date
3 January 2020
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience74
Completeness80
Years active:20State licenses:1Digital endpointsUpdated within 12 months

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Provider Addresses for Publix Pharmacy #0779

  • Boom Box Buns, 1324, Main Street, Main Street Business District, Over-the-Rhine, Cincinnati, Hamilton County, Ohio, 45202, United States

    CINCINNATI, OH 452639680

    Phone: (863) 688-1188

    Fax: (863) 616-5846

    Type: Mailing

  • Eldron Boulevard Southeast, Bayside Lakes, Palm Bay, Brevard County, Florida, 32909, United States

    PALM BAY, FL 329096815

    Phone: (321) 725-3757

    Fax: (321) 725-5881

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2010-09-30

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Revalidation due soon

Earliest CMS due date is 2026-07-31 (54 days away).

Enrollment records

1

Earliest due date

2026-07-31

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
O20100930090542OPharmacyFL2026-07-31

What to do next

  • Confirm the due date on the CMS Revalidation Lookup Tool.
  • Complete revalidation in PECOS before the published due date.
  • If you have multiple enrollment records, revalidate each one on its own schedule.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
K1034Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count58868$0
G0008Administration of influenza virus vaccine251250$0
90694Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage242241$0
90480Admn sarscov2 vacc 1 dose179179$0
91322Sarscov2 vac 50 mcg/0.5ml im168168$0
View full utilization report →

Insurance plans in this area (ZIP 45263)

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Reviews

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Frequently asked questions

What is the standard ID for Publix Pharmacy #0779 in the U.S.?
In the U.S., Publix Pharmacy #0779 is identified by NPI 1619916582.
Should I treat Publix Pharmacy #0779 as an active provider?
Patients and plans typically see Publix Pharmacy #0779 as active in the national extract.
Which specialty label fits Publix Pharmacy #0779?
NPPES ties Publix Pharmacy #0779 to Community/Retail Pharmacy in the taxonomy section. Clinical services aligned with this taxonomy classification.
What geographic area is tied to Publix Pharmacy #0779?
Publix Pharmacy #0779 is associated with Cincinnati, Ohio in the same public data insurers reference.
Who maintains Publix Pharmacy #0779's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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