SHOPKO STORES OPERATING CO LLC (NPI# 1265486039) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265486039 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 041 |
| Practice Address |
1209 18th Ave Nw Austin MN 55912-1881 |
| Practice Telephone | 5074377616 |
| Practice Fax Number | 5074378565 |
| Mailing Telephone | 5074377616 |
| Mailing Fax Number | 5074378565 |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2013-08-27 |
| Authorized Official Name | MR. MICHAEL J BETTIGA (SR. VICE PRESIDENT HEALTH SERVICES) |
| 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 | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
2628024 | MN | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCPDP NUMBER | 2416116 | 01 | |
| MN | 840020000 | 05 | |
| MN | 126023500 | 05 | |
| MN | 608057000 | 05 | |
| IA | 0578674 | 05 |
| Other Name | Type Code |
|---|---|
| ShopKo Pharmacy 041 | 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 |
1209 18TH AVE NW |
| City | AUSTIN |
| State | MN |
| Zip Code | 55912-1881 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962454033 | Rodney L. Middlebrook | Optometrist | 1209 18th Ave Nw, Austin, MN 55912-1881 | 2006-05-17 |
| 1295152619 | Doreen Ann Reed | Pharmacist | 1209 18th Ave Nw, Austin, MN 55912-1881 | 2014-03-24 |
| 1063839561 | Vicki Jean Wilhelm | Pharmacist | 1209 18th Ave Nw, Austin, MN 55912-1881 | 2014-03-21 |
| 1558314104 | Shopko Stores Operating Co. LLC | Eyewear Supplier (Equipment, not the service) | 1209 18th Ave Nw, Austin, MN 55912-1881 | 2006-05-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710538152 | Reliable Medical Supply LLC | Durable Medical Equipment & Medical Supplies | 313 2nd Ave Ne, Austin, MN 55912 | 2019-09-26 |
| 1669029831 | David Kuehn | Specialist/Technologist | 1508 Main St. N, Austin, MN 55912 | 2019-08-22 |
| 1841844396 | Heather A Peterson | Social Worker | 101 21st Street Se, Austin, MN 55912 | 2019-08-01 |
| 1477058287 | Gerard Academy | Counselor | 1101 28th St Ne, Austin, MN 55912 | 2018-03-26 |
| 1821518739 | Steven Register | Specialist/Technologist | 1803 2nd Ave Sw, Austin, MN 55912 | 2017-06-21 |
| 1366849259 | Kristen Ashley Templeton | Dentist | 800 1st Avenue Sw, Austin, MN 55912 | 2014-11-20 |
| 1336560333 | Rem Woodvale, Inc. Cottonwood | Intermediate Care Facility, Mentally Retarded | 2311 9th Avenue Sw, Austin, MN 55912 | 2013-12-18 |
| 1780923458 | Kurt Baumgartner | Hearing Instrument Specialist | 507 1 St Nw, Austin, MN 55912 | 2013-01-31 |
| 1396059242 | Lorna Kay Siefke-harbor | Psychologist | 902 19th Ave Sw, Austin, MN 55912 | 2010-08-03 |
| 1972777068 | Stanley Brent Stutzman | Psychologist | 301 12 Place Nw, Austin, MN 55912 | 2008-04-18 |
| Find all providers in zip 55912 | ||||
| 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 in AUSTIN | ||||
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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.