SHOPKO STORES OPERATING CO LLC (NPI# 1790731438) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790731438 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 020 |
| Practice Address |
2400 Rose St La Crosse WI 54603-1612 |
| Practice Telephone | 6087813300 |
| Practice Fax Number | 6087837810 |
| Mailing Telephone | 6087813300 |
| Mailing Fax Number | 6087837810 |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2008-08-06 |
| 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 | 333600000X | Pharmacy | Suppliers | ||
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
8613042 | WI | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCPDP NUMBER | 5106516 | 01 | |
| WI | 33135500 | 05 | |
| MN | 883693000 | 05 | |
| MN | 423358100 | 05 |
| Other Name | Type Code |
|---|---|
| ShopKo Pharmacy 020 | 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 |
2400 ROSE ST |
| City | LA CROSSE |
| State | WI |
| Zip Code | 54603-1612 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174933295 | Justin C Stakston | Pharmacist | 2400 Rose St, La Crosse, WI 54603-1612 | 2014-04-28 |
| 1194158865 | John Patrick Smieja | Pharmacist | 2400 Rose St, La Crosse, WI 54603 | 2013-08-16 |
| 1316388499 | Trisha Stroyny | Pharmacist | 2400 Rose St, La Crosse, WI 54603-1612 | 2013-07-17 |
| 1639510209 | Anita Lindvig | Pharmacist | 2400 Rose St, La Crosse, WI 54603-1612 | 2013-07-11 |
| 1417393315 | Rhonda Wine | Pharmacist | 2400 Rose St, La Crosse, WI 54603-1612 | 2013-05-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215581855 | Sophia Buchda | Behavior Technician | 901 Caledonia Street, La Crosse, WI 54603 | 2019-08-01 |
| 1891142865 | Hha of Wisconsin, LLC | Home Health | 2400 Rose St Ste 14, La Crosse, WI 54603 | 2016-05-19 |
| 1225415540 | Alexander Blaschke | Podiatrist | 1009 Caledonia St, La Crosse, WI 54603 | 2015-05-06 |
| 1982986345 | Christopher W Hutchinson | Pharmacist | 2626 Rose Street, La Crosse, WI 54603 | 2011-09-12 |
| 1932284494 | Vision World Inc | Eyewear Supplier (Equipment, not the service) | 3800 State Road 16, La Crosse, WI 54603 | 2006-10-25 |
| 1083618722 | Teddy Leonard Thompson | Family Medicine | 1526 Rose Street, La Crosse, WI 54603 | 2005-06-10 |
| 1518459155 | Alexis Ericson | Occupational Therapy Assistant | 901 Caledonia St, La Crosse, WI 54603 | 2018-05-30 |
| 1578925046 | Vicki Lynne Iverson | Registered Nurse | 1407 St. Andrew St., La Crosse, WI 54603 | 2016-03-24 |
| 1275726663 | Jacqueline Berry Newcomb | Case Manager/Care Coordinator | 1407 St Andrew St, Suite 100 Lacrosse Co Human Services, La Crosse, WI 54603 | 2007-08-20 |
| 1164624920 | Kimberly Ann Connor | Case Manager/Care Coordinator | 1407 St Andrew St, Suite 100, La Crosse, WI 54603 | 2007-06-04 |
| Find all providers in zip 54603 | ||||
| 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 |
|---|---|---|---|---|
| 1629490255 | Genoa Healthcare, LLC | Pharmacy | 1707 Main St Ste 102, La Crosse, WI 54601-4200 | 2014-01-16 |
| 1245276260 | Barrows Healthmart Pharmacy | Pharmacy | 721 Main, La Crosse, KS 67548 | 2006-06-20 |
| 1497299762 | Pharmacy Compounding Center Associates LLC | Pharmacy | 1907 West Ave S, La Crosse, WI 54601-6206 | 2016-12-06 |
| 1679920698 | Rush County Pharmacy LLC | Pharmacy | 708 Main St, La Crosse, KS 67548 | 2016-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942816939 | The Duluth Clinic, Ltd. | Pharmacy | 204 Belknap St, Ste 100, Superior, WI 54880-2964 | 2020-09-16 |
| 1902417207 | Ipack Pharmacy LLC | Pharmacy | 17000 W North Ave Ste 108w, Brookfield, WI 53005-4423 | 2020-08-11 |
| 1851939037 | Ascension Wisconsin Pharmacy, Inc | Pharmacy | 10180 Washington Ave Ste 102, Mount Pleasant, WI 53177-1604 | 2019-12-18 |
| 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 | ||||
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.