SHOPKO STORES OPERATING CO LLC (NPI# 1023063757) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1023063757 |
Entity Type | Organization |
Organization Name | SHOPKO STORES OPERATING CO LLC |
Other Organization Name | SHOPKO PHARMACY 738 |
Practice Address |
300 Jake St Perham MN 56573 |
Mailing Address |
Po Box 10 Perham MN 56573-0010 |
Practice Telephone | 2183467751 |
Practice Fax Number | 2183467752 |
Mailing Telephone | 2183467751 |
Mailing Fax Number | 2183467752 |
Enumeration Date | 2006-05-23 |
Last Update Date | 2012-09-24 |
Authorized Official Name | MR. MICHAEL BETTIGA (EXECUTIVE VICE PRESIDENT & COO) |
Authorized Official Telephone | 9204294297 |
Authorized Official Credential | RPH |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 333600000X | Pharmacy | Suppliers | ||
N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
NCPDP | 2421511 | 01 | |
MN | 300559300 | 05 | |
MN | 208187000 | 05 |
Other Name | Type Code |
---|---|
Shopko Pharmacy 738 | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1275017907 | Shopko Stores Operating Co LLC | Eyewear Supplier (Equipment, not the service) | 1166 W Sunset Drive, Suite F100, Waukesha, WI 53189 | 2018-09-19 |
1871076968 | Shopko Stores Operating Co LLC | Eyewear Supplier (Equipment, not the service) | 1810 Jackson St, Oshkosh, WI 54901-2204 | 2018-09-13 |
1427547082 | Shopko Stores Operating Co LLC | Eyewear Supplier (Equipment, not the service) | 10996 N Port Washington Rd, Mequon, WI 53092 | 2018-05-08 |
1912454505 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 908 Nw 6th St, Tulia, TX 79088 | 2016-09-01 |
1821545419 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 67 Selkirk Way, Oldtown, ID 83822 | 2016-09-01 |
1740736586 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 94 North 400 East, Delta, UT 84624 | 2016-08-31 |
1639625064 | Shopko Stores Operating Co LLC | Pharmacy | 1001 N Center Ave, Hardin, MT 59034-1101 | 2016-08-26 |
1649726076 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 1635 E Highway 40, Ballard, UT 84066-5217 | 2016-08-26 |
1841745155 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 301 E Us Highway 20, Gordon, NE 69343-1650 | 2016-08-17 |
1821441205 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 6355 Main St, Bonners Ferry, ID 83805-8519 | 2016-07-20 |
Street Address |
300 JAKE ST |
City | PERHAM |
State | MN |
Zip Code | 56573 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1558630012 | Perham Hospital District | Durable Medical Equipment & Medical Supplies | 1000 Coney Street West, Perham, MN 56573 | 2011-12-29 |
1730239385 | Dr. Kelvin K. Salathe, P.C. | Chiropractor | 101 West Coney St, Perham, MN 56573 | 2007-01-12 |
1124106299 | Langen Family Chiropractic, P.a. | Chiropractor | 108 Market Dr., Perham, MN 56573 | 2006-11-02 |
1285710335 | James Odin Langen | Chiropractor | 108 Market Drive, Perham, MN 56573 | 2006-10-31 |
1578572202 | Michael L Hamann | Dentist | 200 1st Ave S, Perham, MN 56573 | 2006-08-05 |
1033133517 | Timothy Charles Neitzke | Optometrist | 340 Fox St, Perham, MN 56573 | 2006-07-27 |
1164917233 | Katlin Larson | Behavior Technician | 735 3rd St Sw, Perham, MN 56573 | 2018-06-29 |
1104029347 | Tammy L Sturdevant | Dentist | 335 4th Ave, Perham, MN 56573 | 2007-06-06 |
1861610131 | Minnesota Eyecare Network Inc. | Eyewear Supplier (Equipment, not the service) | 340 Fox Street, Perham, MN 56573 | 2007-04-23 |
1194793562 | Richard W Masur | Emergency Medicine | 665 3rd St Sw, Perham, MN 56573-1108 | 2006-03-10 |
Find all providers in zip 56573 |
Taxonomy Code | 3336C0003X |
Grouping | Suppliers |
Classification | Pharmacy |
Specialization | Community/Retail Pharmacy |
A 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. |
Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
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Find all providers with the same taxonomy |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.