SHOPKO STORES OPERATING CO LLC (NPI# 1619922028) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619922028 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 503 |
| Practice Address |
1011 N Wisconsin St Port Washington WI 53074-1207 |
| Practice Telephone | 2622843436 |
| Practice Fax Number | 2622843422 |
| Mailing Telephone | 2622843436 |
| Mailing Fax Number | 2622843422 |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2008-08-15 |
| 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 | 333600000X | Pharmacy | Suppliers | ||
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
8611042 | WI | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCPDP | 5128017 | 01 | |
| WI | 33277300 | 05 |
| Other Name | Type Code |
|---|---|
| ShopKo Pharmacy 503 | 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 |
1011 N WISCONSIN ST |
| City | PORT WASHINGTON |
| State | WI |
| Zip Code | 53074-1207 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073959748 | Martin T Becker | Pharmacist | 1011 N Wisconsin St, Port Washington, WI 53074-1207 | 2013-05-21 |
| 1750634390 | Brian A Weir | Pharmacist | 1011 N Wisconsin St, Port Washington, WI 53074-1207 | 2012-10-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962045864 | Heather Kay Brede | Technician | 857 Ashley Avenue, Port Washington, WI 53074 | 2019-10-23 |
| 1780062034 | Amanda Zitzer | Specialist/Technologist | 1037 S Spring Street, Apt 257, Port Washington, WI 53074 | 2015-05-07 |
| 1639507643 | Kelly Mulder | Occupational Therapy Assistant | 138 E Prospect St, Port Washington, WI 53074 | 2013-10-30 |
| 1235310921 | Susan Ann Dobberpuhl | Occupational Therapist | 306 N Sprint St, Port Washington, WI 53074 | 2007-11-21 |
| 1245444736 | Lee B Raffel | Social Worker | 3632 E Norport Drive, Port Washington, WI 53074 | 2007-05-10 |
| 1023143708 | Joshua E Leute | Dentist | 1317 West Grand Avenue, Port Washington, WI 53074 | 2007-02-22 |
| 1578633806 | Robert Andrew Kortsch | Dentist | 457 W Grand Ave, Port Washington, WI 53074 | 2006-11-08 |
| 1538256409 | Daniel P Witkowski | Dentist | 1612 N Wisconsin St, Port Washington, WI 53074 | 2006-10-10 |
| 1477584878 | Francine L Cosner | Obstetrics & Gynecology | 1777 W Grand Avenue, Port Washington, WI 53074 | 2006-07-05 |
| 1013953926 | Port Washington Podiatry Inc | Podiatrist | 1317 W Grand Avenue, Port Washington Podiatry, Port Washington, WI 53074 | 2006-06-20 |
| Find all providers in zip 53074 | ||||
| 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 |
|---|---|---|---|---|
| 1871674531 | Port Salem Pharmacy Corp | Pharmacy | 370 Port Washington Blvd, Port Washington, NY 11050 | 2006-10-18 |
| 1306870522 | Aurora Pharmacy Inc | Pharmacy | 1475 W Grand Ave, Port Washington, WI 53074-2074 | 2006-07-11 |
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| 1558906354 | Life Change Rx 4 LLC | Pharmacy | 6300 N 76th St Ste 246, Milwaukee, WI 53218-1208 | 2019-11-15 |
| 1285278978 | Life Change Rx 3 LLC | Pharmacy | 7115 W Capitol Dr, Milwaukee, WI 53216-2051 | 2019-11-05 |
| 1295377703 | Hayat Pharmacy 21 LLC. | Pharmacy | 2333 Northwestern Ave Ste 120, Racine, WI 53404-2520 | 2019-10-16 |
| 1487296737 | Xperience Pharmacy LLC | Pharmacy | 5715 W Appleton Ave, Milwaukee, WI 53210-2250 | 2019-10-08 |
| 1962053421 | Hayat Pharmacy 19 LLC | Pharmacy | 805 W. Layton Ave. Suite A, Milwaukee, WI 53221 | 2019-09-26 |
| 1275182925 | Walgreen Co | Pharmacy | 2265 N Mayfair Rd, Wauwatosa, WI 53226-2207 | 2019-09-05 |
| 1982257200 | Hayat Pharmacy 16 LLC | Pharmacy | 603 N 36th St, Milwaukee, WI 53208-3826 | 2019-07-17 |
| Find all providers with the same taxonomy | ||||
| City | PORT WASHINGTON |
| Zip Code | 53074 |
Please comment or provide details below to improve the information on SHOPKO STORES OPERATING CO LLC.
| 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.