SHOPKO STORES OPERATING CO LLC (NPI# 1184895336) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184895336 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 514 |
| Practice Address |
1960 South Morey Road Lake City MI 49651 |
| Mailing Address |
Po Box 399 1960 South Morey Road Lake City MI 49651 |
| Practice Telephone | 2318397207 |
| Practice Fax Number | 2318394142 |
| Mailing Telephone | 2318397207 |
| Mailing Fax Number | 2318394142 |
| Enumeration Date | 2008-03-17 |
| Last Update Date | 2013-02-15 |
| 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 | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| Other Name | Type Code |
|---|---|
| Shopko Pharmacy 514 | 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 |
1960 SOUTH MOREY ROAD |
| City | LAKE CITY |
| State | MI |
| Zip Code | 49651 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205463312 | Andrea Huxtable | Student in an Organized Health Care Education/Training Program | 1800-200 S Sweetbriar Ave, Lake City, MI 49651 | 2020-03-26 |
| 1316482300 | Suzanne Smith | Massage Therapist | 102 B S. Main St, Lake City, MI 49651 | 2016-12-29 |
| 1184960734 | Shanel Lynette Seger | Occupational Therapy Assistant | 1900 S Lachance Road, Lake City, MI 49651 | 2012-12-28 |
| 1265705347 | David Robert Kramp | Physical Therapist | 1900 South Lachance Rd, Lake City, MI 49651 | 2012-02-20 |
| 1396072708 | Footprints In Time | Voluntary or Charitable | 805 Mitchell St., Lake City, MI 49651 | 2009-11-05 |
| 1396965752 | Chris Klein Otr Plc | Occupational Therapist | 805 Mitchell St, Lake City, MI 49651 | 2007-04-26 |
| 1033253133 | John Street Clinic PC | Pediatrics | 112 E John St, Lake City, MI 49651 | 2007-02-20 |
| 1659435287 | Michael Francis Lahey | Dentist | 301 N Main, Lake City, MI 49651 | 2006-12-20 |
| 1215019781 | Christine Louise Klein | Occupational Therapist | 805 Mitchell, Lake City, MI 49651 | 2006-10-20 |
| 1952896151 | Lake City Primary Care PC | Clinic/Center | 1866 S Morey Rd, Lake City, MI 49651 | 2018-06-29 |
| Find all providers in zip 49651 | ||||
| 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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| 1821606310 | S&k Pharmacy Inc. | Pharmacy | 1916 Davison Rd, Flint, MI 48506-4423 | 2020-07-21 |
| 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.