SHOPKO STORES OPERATING CO LLC (NPI# 1093983132) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093983132 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 765 |
| Practice Address |
1080 Hwy 414 Mountain View WY 82939-0219 |
| Mailing Address |
Po Box 219 Mountain View WY 82939-0219 |
| Practice Telephone | 3077877922 |
| Practice Fax Number | 3077827924 |
| Mailing Telephone | 3077827922 |
| Mailing Fax Number | 3077827924 |
| Enumeration Date | 2008-02-12 |
| Last Update Date | 2012-12-27 |
| Authorized Official Name | MR. MICHAEL BETTIGA (EXECUTIVE VICE PRESIDENT AND COO) |
| Authorized Official Telephone | 9204294297 |
| Authorized Official Credential | RPH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WY | 125693900 | 05 |
| Other Name | Type Code |
|---|---|
| Shopko Pharmacy 765 | 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 |
1080 HWY 414 |
| City | MOUNTAIN VIEW |
| State | WY |
| Zip Code | 82939-0219 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205265097 | Bryce Habel | Pharmacist | 1080 Hwy 414, Mountain View, WY 82939 | 2013-11-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013568922 | Paul R Burpo Jr. | Pharmacist | 950 N Hwy 414, Mountain View, WY 82939 | 2019-09-23 |
| 1770043234 | Bvp LLC | Pharmacy | 950 N. Hwy 414, Mountain View, WY 82939 | 2019-03-21 |
| 1508322603 | Blacks Fork Dental, PC | Clinic/Center | 650 Parkway Dr, Mt View, WY 82939 | 2019-02-13 |
| 1073062774 | Kirstin Dennis | Speech-Language Pathologist | 1001 Hwy 414 North, Mountain View, WY 82939 | 2016-09-23 |
| 1639525702 | Alliance Case Management | Case Manager/Care Coordinator | 657 Parkway Dr., Mountain View, WY 82939 | 2016-05-09 |
| 1609175405 | Sandra Lee Jones | Case Manager/Care Coordinator | 210 Riverbend Drive, Mountain View, WY 82939 | 2011-03-18 |
| 1184922007 | Jeffery La Von Walker | Case Manager/Care Coordinator | 210 Riverbend Dr., Mountain View, WY 82939 | 2011-03-01 |
| 1992034128 | Lincoln Uinta Child Development Association | Case Management | 1050 Highway 414, Mountain View, WY 82939 | 2009-12-17 |
| 1548599970 | Susan Parkinson | Case Manager/Care Coordinator | 3284 Aspen Lane, Box 969, Mountain View, WY 82939 | 2009-12-14 |
| 1356572101 | Steven Wayne Babcock | Family Medicine | 531 Parkway Drive, Mountain View, WY 82939 | 2009-07-28 |
| Find all providers in zip 82939 | ||||
| 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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| 1245602598 | Rkj Holdings LLC | Pharmacy | 508-2 W. Us 60, Mountain View, MO 65548 | 2015-10-27 |
| 1447503941 | Mitchell's Main Street Pharmacy, Inc | Pharmacy | 214 East Main St, Mountain View, AR 72560 | 2012-10-22 |
| 1124392147 | Walgreen Co | Pharmacy | 1905 W El Camino Real, Mountain View, CA 94040-2216 | 2012-03-08 |
| 1770819674 | Los Altos Pharmacy At El Camino Hospital | Pharmacy | 2500 Grant Rd Ste 1b20, Mountain View, CA 94040-4302 | 2009-10-27 |
| 1962417238 | Walgreen Co | Pharmacy | 121 E El Camino Real, Mountain View, CA 94040-2701 | 2006-07-29 |
| 1114969946 | Longs Drug Stores California LLC | Pharmacy | 2630 W El Camino Real, Mountain View, CA 94040-1117 | 2006-06-13 |
| 1740818103 | Moonjung April Kim | Pharmacy | 121 E El Camino Real, Mountain View, CA 94040-2701 | 2020-03-31 |
| 1306031059 | Longs Drug Stores California, LLC. | Pharmacy | 850 California St, Mountain View, CA 94041 | 2007-09-06 |
| 1871640193 | Kaiser Foundation Health Plan Inc | Pharmacy | 555 Castro St, Mountain View, CA 94041-2009 | 2007-01-05 |
| Find all providers in MOUNTAIN VIEW | ||||
| City | MOUNTAIN VIEW |
| Zip Code | 82939 |
Please comment or provide details below to improve the information on SHOPKO STORES OPERATING CO LLC.
| 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.