SHOPKO STORES OPERATING CO LLC (NPI# 1376842286) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376842286 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY |
| Practice Address |
705 Northland Dr Princeton MN 55371-2168 |
| Mailing Address |
700 Pilgrim Way Po Box 19060 Green Bay WI 54304-5263 |
| Practice Telephone | 7633893111 |
| Practice Fax Number | 7633891621 |
| Mailing Telephone | 9204297137 |
| Mailing Fax Number | 9204294649 |
| Enumeration Date | 2011-03-17 |
| Last Update Date | 2011-12-09 |
| Authorized Official Name | MICHAEL BETTIGA (EXECUTIVE VP & COO) |
| Authorized Official Telephone | 9204294297 |
| 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 | 263663 | MN | Suppliers |
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
263663 | MN | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 1376842286 | 05 | |
| NCPDP PROVIDER IDENTIFICATION NUMBER | 2430786 | 01 |
| Other Name | Type Code |
|---|---|
| Shopko Pharmacy | 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 |
705 NORTHLAND DR |
| City | PRINCETON |
| State | MN |
| Zip Code | 55371-2168 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003869272 | Pamida Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 705 Northland Dr, Princeton, MN 55371-2168 | 2006-05-18 |
| 1700043734 | Jacalyn Nelson | Pharmacist | 705 Northland Dr, Princeton, MN 55371-2168 | 2008-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053962530 | Monica Gail Broten | Technician | 30840 Tiger Street Nw, Princeton, MN 55371 | 2019-09-25 |
| 1215349584 | Stephen Destefano | Pharmacist | 31419 131st Street, Princeton, MN 55371 | 2014-05-21 |
| 1164798948 | Andrew Sudbeck | Counselor | 101 18th Avenue North, Princeton, MN 55371 | 2012-03-27 |
| 1073804803 | Sterling Pointe Senior Living LLC | Assisted Living Facility | 1250 Northland Drive, Princeton, MN 55371 | 2011-04-27 |
| 1568752533 | Rum River Health Services, Inc. | Substance Abuse Rehabilitation Facility | 3079 90th Avenue, Princeton, MN 55371 | 2011-04-12 |
| 1780989038 | Dr. Kynan Westermeyer, Dds, Pllc | Clinic/Center | 404 1st St. N, Princeton, MN 55371 | 2011-01-18 |
| 1275788085 | Cody James Leff | Pharmacist | 1100 11th Avenue South, Princeton, MN 55371 | 2008-11-20 |
| 1164679213 | Rum River Health Services, Inc | Substance Abuse Rehabilitation Facility | 1101 N 5th St, Princeton, MN 55371 | 2008-08-20 |
| 1801059639 | Rum River Health Services, Inc | Substance Abuse Rehabilitation Facility | 1506 1st Street, Princeton, MN 55371 | 2008-07-02 |
| 1497940928 | James Michael Mandt | Pharmacist | 911 Northland Drive, Fairview Northland Medical Center, Princeton, MN 55371 | 2007-09-07 |
| Find all providers in zip 55371 | ||||
| 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] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699112284 | Thirumala Group LLC | Pharmacy | 100 W Princeton Dr # A, Princeton, TX 75407-9607 | 2013-05-23 |
| 1235576877 | Thirumala Group LLC | Pharmacy | 201 E Princeton Dr, Princeton, TX 75407-9005 | 2013-05-22 |
| 1538402342 | Wal-mart Stores East Lp | Pharmacy | 509 Doctor Donnie H Jones Jr Blvd W, Princeton, NC 27569-6820 | 2013-03-29 |
| 1043554504 | Walmart Inc. | Pharmacy | 300 21st Ave N, Princeton, MN 55371-6271 | 2012-11-21 |
| 1184862146 | Aydil Healthcare, Pllc | Pharmacy | 501 E Princeton Dr # 100, Princeton, TX 75407 | 2009-01-29 |
| 1396959938 | Princeton Pharmacy, Inc | Pharmacy | 610 N Main Street, Princeton, IL 61356-2006 | 2007-05-10 |
| 1043352537 | Princeton Pharmacy Inc. | Pharmacy | 501 E. Princeton Dr, Suite 100, Princeton, TX 75407 | 2007-02-13 |
| 1568557031 | E. W. James and Sons, Inc | Pharmacy | 550 U. S. Hwy 62 West, Princeton, KY 42445 | 2006-10-03 |
| 1912099516 | New Jersey Cvs Pharmacy LLC | Pharmacy | 881 State Rd # 206, Princeton, NJ 08540-1436 | 2006-09-29 |
| 1366533796 | Hobert Drugs Inc | Pharmacy | 115 N Rum River Dr, Princeton, MN 55371-1616 | 2006-09-28 |
| Find all providers in PRINCETON | ||||
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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.