SHOPKO STORES OPERATING CO LLC (NPI# 1386690733) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386690733 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 100 |
| Practice Address |
699 Green Bay Rd Neenah WI 54956-3153 |
| Practice Telephone | 9207510270 |
| Practice Fax Number | 9207510267 |
| Mailing Telephone | 9207510270 |
| Mailing Fax Number | 9207510267 |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2014-06-06 |
| 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 | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers | ||
| N | 333600000X | Pharmacy | Suppliers | ||
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
8599042 | WI | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCPDP | 5120136 | 01 | |
| WI | 33170900 | 05 |
| Other Name | Type Code |
|---|---|
| ShopKo Pharmacy 100 | 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 |
699 GREEN BAY RD |
| City | NEENAH |
| State | WI |
| Zip Code | 54956-3153 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730131319 | Richard M. Rowe | Optometrist | 699 Green Bay Rd, Neenah, WI 54956-3153 | 2006-05-16 |
| 1912950619 | Shopko Stores Operating Co. LLC | Eyewear Supplier (Equipment, not the service) | 699 Green Bay Rd, Neenah, WI 54956-3153 | 2006-05-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447768411 | Wisconsin Institute of Surgical Excellence LLC | Clinic/Center | 1265 W American Dr Ste 200, Neenah, WI 54956 | 2018-01-12 |
| 1639614290 | Clinton Robert Murchland | Pharmacist | 828 Fox Point Plaza, Pharmacy, Neenah, WI 54956 | 2017-01-05 |
| 1629448550 | Melissa Christine Hewitt | Physical Therapy Assistant | 1119 Higgins Ave, Neenah, WI 54956 | 2015-10-05 |
| 1437581923 | Ross Phan | Pharmacist | 1432 Seymour Crt, Neenah, WI 54956 | 2013-08-06 |
| 1518201318 | Meridith Nealy Starling | Social Worker | 124 W Wisconsin Ave, Suite 90 B, Neenah, WI 54956 | 2012-11-16 |
| 1639464886 | Wisconsin Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 901 S. Green Bay Rd, Neenah, WI 54956 | 2011-06-16 |
| 1669701439 | Donna Jean Falk | Licensed Practical Nurse | 1037 B Hunt Ave, Neenah, WI 54956 | 2009-12-08 |
| 1285868257 | Angela Marie Bilbrey | Dietitian, Registered | 307 S Commercial St Ste 101, Neenah, WI 54956 | 2009-05-06 |
| 1003083114 | A B See Vision Therapy Centers Sc | Optometrist | 1401 Mcmahon Dr., Suite 100, Neenah, WI 54956 | 2008-05-08 |
| 1629244173 | Tamra Marie Knutson | Radiology | 333 N Commercial St #100, Neenah, WI 54956 | 2008-05-05 |
| Find all providers in zip 54956 | ||||
| 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 |
|---|---|---|---|---|
| 1629227020 | Roundys Supermarkets Inc | Pharmacy | 828 Fox Point Plz, Neenah, WI 54956-3781 | 2008-09-10 |
| 1609883586 | Walgreen Co | Pharmacy | 500 S Commercial St, Neenah, WI 54956-3383 | 2006-08-02 |
| 1649204868 | Aurora Pharmacy Inc | Pharmacy | 1136 Westowne Dr, Suite 1530, Neenah, WI 54956-2175 | 2006-07-11 |
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| 1982257200 | Hayat Pharmacy 16 LLC | Pharmacy | 603 N 36th St, Milwaukee, WI 53208-3826 | 2019-07-17 |
| 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.