SHOPKO STORES OPERATING CO LLC (NPI# 1902859317) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902859317 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 680 |
| Practice Address |
1305 141st St Perry IA 50220-8128 |
| Practice Telephone | 5154655484 |
| Practice Fax Number | 5154655484 |
| Mailing Telephone | 5154655484 |
| Mailing Fax Number | 5154655484 |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2013-01-28 |
| Authorized Official Name | MR. MICHAEL BETTIGA (EXECUTIVE VICE PRESIDENT AND 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 |
|---|---|---|---|
| NCPDP | 1619482 | 01 | |
| IA | 0178251 | 05 | |
| IA | 0495820 | 05 |
| Other Name | Type Code |
|---|---|
| Shopko Pharmacy 680 | 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 |
1305 141ST ST |
| City | PERRY |
| State | IA |
| Zip Code | 50220-8128 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558675983 | Mike Mckie | Pharmacist | 1305 141st St, Perry, IA 50220-8128 | 2010-07-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407405897 | Tanna Corrigan | Technician | 2628 Marengo Dr, Perry, IA 50220 | 2019-09-09 |
| 1053963900 | Nicole Dora Mcclavy | Nurse Practitioner | 610 10th St, Perry, Ia 50220, Perry, IA 50220 | 2019-07-11 |
| 1881816882 | Rachel Fazio | Occupational Therapist | 2625 Iowa St, Perry, IA 50220 | 2007-05-02 |
| 1558485151 | Angela Faye Hansen-abbas | Occupational Therapist | 161 315th Street, Perry, IA 50220 | 2007-03-19 |
| 1356405658 | Eye Care Associates PC | Optometrist | 1313 2nd St., Perry, IA 50220 | 2006-12-20 |
| 1962591800 | Nabil Nakhla Faltas | Radiology | 610 10th Street, Dallas Co Hospital, Perry, IA 50220 | 2006-10-11 |
| 1508959172 | Renal Treatment Centers Illinois Inc | Clinic/Center | 610 10th St Ste L100, Perry, IA 50220 | 2006-10-02 |
| 1790702207 | Todd R Miller | Podiatrist | 612 10th St, Perry, IA 50220 | 2006-07-17 |
| 1750349411 | Chad M Kuehl | Physical Therapist | 610 10t St, Perry, IA 50220 | 2006-05-03 |
| 1942672563 | Ronda Hemann | Counselor | 610 10th Street, Perry, IA 50220 | 2015-10-22 |
| Find all providers in zip 50220 | ||||
| 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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| 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.