SHOPKO STORES OPERATING CO LLC (NPI# 1588616965) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588616965 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 676 |
| Practice Address |
1901 W Court Ave Chariton IA 50049-1905 |
| Practice Telephone | 6417745505 |
| Practice Fax Number | 6417745403 |
| Mailing Telephone | 6417745505 |
| Mailing Fax Number | 6417745403 |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2013-01-23 |
| 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 |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IA | 0421305 | 05 | |
| IA | 0495838 | 05 | |
| NCPDP | 1621730 | 01 |
| Other Name | Type Code |
|---|---|
| Shopko Pharmacy 676 | 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 |
1901 W COURT AVE |
| City | CHARITON |
| State | IA |
| Zip Code | 50049-1905 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952838633 | Kimberly Dawn Pace | Counselor | 115 S. Main St, Chariton, IA 50049 | 2017-05-12 |
| 1790801314 | Northridge Assisted Living, LLC | Assisted Living Facility | 1110 North 6th Street, Chariton, IA 50049 | 2007-03-22 |
| 1710019054 | David John Randall | Dentist | 818 Braden Avenue, Chariton, IA 50049 | 2007-03-12 |
| 1417015595 | Rodney R Stream | Dentist | 934 N 7th Street, Chariton, IA 50049 | 2006-12-04 |
| 1497062558 | Peter Kenneth Hoftiezer | Family Medicine | 1200 N 7th St, Chariton, IA 50049 | 2010-09-09 |
| 1477648376 | Juanita Louise Durham | Nurse Practitioner | 1030 N 7th St, Chariton, IA 50049-1206 | 2006-10-04 |
| 1780665240 | Circle of Friends Home Care | Home Health | 1010 N 7th St, Chariton, IA 50049-1206 | 2005-11-10 |
| 1558847749 | Caregivers of Chariton, LLC | Home Health | 1010 N 7th St, Chariton, IA 50049-1206 | 2018-07-11 |
| 1447741483 | Community Health Centers of Southern Iowa, Inc | Clinic/Center | 1030 N 7th St, Chariton, IA 50049-1206 | 2018-05-25 |
| 1942516471 | Red Haw Family Medical Center, PC | Obstetrics & Gynecology | 1030 N 7th St, Chariton, IA 50049-1206 | 2010-08-21 |
| Find all providers in zip 50049 | ||||
| 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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| 1306304027 | State University of Iowa | Pharmacy | 1360 N Dodge St Ste 1100, Iowa City, IA 52245-6104 | 2019-03-12 |
| 1265999387 | Bancroft Apothecary Lp | Pharmacy | 106 W Ramsey St, Bancroft, IA 50517-8078 | 2019-02-25 |
| 1023588159 | Mark Oleson | Pharmacy | 1100 Broad Street, Adair, IA 50002 | 2018-12-02 |
| 1598235723 | Cjk Pharmacy, LLC | Pharmacy | 3100 E Ave Nw Ste 102, Cedar Rapids, IA 52405-2962 | 2018-11-30 |
| 1144701582 | Madsen Inc | Pharmacy | 307 2nd. St., Gladbrook, IA 50635-5063 | 2018-08-23 |
| 1376024869 | Hy Vee Inc | Pharmacy | 3285 Crosspark Road, Coralville, IA 52241 | 2018-08-23 |
| 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.