SHOPKO STORES OPERATING CO LLC (NPI# 1699728469) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699728469 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 057 |
| Practice Address |
405 Cottonwood Dr Winona MN 55987-1914 |
| Practice Telephone | 5074521244 |
| Practice Fax Number | 5074573526 |
| Mailing Telephone | 5074521244 |
| Mailing Fax Number | 5074573526 |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2008-08-07 |
| 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 |
2628037 | MN | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCPDP NUMBER | 2417865 | 01 | |
| WI | 33070000 | 05 | |
| MN | 676758300 | 05 | |
| MN | 057482000 | 05 |
| Other Name | Type Code |
|---|---|
| ShopKo Pharmacy 057 | 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 |
405 COTTONWOOD DR |
| City | WINONA |
| State | MN |
| Zip Code | 55987-1914 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316998404 | Thomas Lee Dahlby | Optometrist | 405 Cottonwood Dr, Winona, MN 55987-1914 | 2006-05-13 |
| 1487028080 | Eric Newenhouse | Pharmacist | 405 Cottonwood Dr, Winona, MN 55987-1914 | 2015-11-19 |
| 1043639339 | Eric A. Swaney | Pharmacist | 405 Cottonwood Dr, Winona, MN 55987-1914 | 2014-04-15 |
| 1346667425 | Catherine Tesmer | Pharmacist | 405 Cottonwood Dr, Winona, MN 55987-1914 | 2014-03-26 |
| 1376595439 | Shopko Stores Operating Co. LLC | Eyewear Supplier (Equipment, not the service) | 405 Cottonwood Dr, Winona, MN 55987-1914 | 2006-05-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891277232 | Jamie Sanders | Social Worker | 51 East 4th St Suite 307, Winona, MN 55987 | 2018-09-01 |
| 1841727823 | Stacey A Czaplewski | Specialist/Technologist | 175 West Mark Street, Winona State University-139 Memorial Hall, Winona, MN 55987 | 2017-05-22 |
| 1083145361 | Kevin Lee Knack | Counselor | 902 E. Second St. Suite 326, Acumen Counseling, Winona, MN 55987 | 2017-03-27 |
| 1467993865 | Melissa Lee Peterson | Specialist/Technologist | 23559 Co. Rd. 20, Winona, MN 55987 | 2017-03-17 |
| 1790226280 | Nikolas Porter Lyon | Specialist/Technologist | 634 Franklin St, East Lake B 306-4, Winona, MN 55987 | 2017-03-16 |
| 1821424953 | Sara Beth Borchardt | Chiropractor | 1423 West Service Drive, Winona, MN 55987 | 2013-09-20 |
| 1952614273 | Kristin Janelle Noble | Chiropractor | 117 W. 3rd St., Winona, MN 55987 | 2010-07-15 |
| 1033435615 | Christine E. Clark | Pharmacist | 1122 Hwy 61, Winona, MN 55987 | 2010-04-08 |
| 1346401544 | Andrew Dean Mork | Dentist | 50 W Second Street, Winona, MN 55987 | 2008-06-19 |
| 1508073693 | Lawrence J Green | Psychologist | 61 W 4th St, Winona, MN 55987 | 2007-05-17 |
| Find all providers in zip 55987 | ||||
| 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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|---|---|---|---|---|
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| 1518034347 | Hammonds Pharmacy Inc | Pharmacy | 405c N Applegate, Winona, MS 38967 | 2006-11-29 |
| 1417979105 | Grand St Paul Cvs LLC | Pharmacy | 860 Mankato Ave, Winona, MN 55987-4867 | 2006-07-24 |
| 1144521089 | Winona Health Services | Pharmacy | 859 Mankato Ave, Winona, MN 55987-6435 | 2010-11-09 |
| 1154341501 | Roger F Harwich Charles W Rogers Sidney Hughes Etal | Pharmacy | 859 Mankato Ave, Winona, MN 55987-6435 | 2006-07-20 |
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| 1801438361 | The Duluth Clinic, Ltd. | Pharmacy | 2 Division St Ste A, Deer River, MN 56636-8779 | 2019-10-16 |
| 1265084792 | Nudak Ventures, LLC | Pharmacy | 5418 Saint Croix Trl, North Branch, MN 55056-4203 | 2019-07-15 |
| 1659938116 | Sterlingrx Inc | Pharmacy | 1312 Northland Dr Ste 500, Mendota Heights, MN 55120-1436 | 2019-05-21 |
| 1639734346 | Seward Pharmacy LLC | Pharmacy | 2209 E Lake St, Minneapolis, MN 55407-4563 | 2019-05-08 |
| 1093370694 | Minnesota Ave N Pharmacy Services Limited | Pharmacy | 226 Minnesota Ave N, Aitkin, MN 56431-1412 | 2019-05-08 |
| 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.