SHOPKO STORES OPERATING CO LLC (NPI# 1922386275) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922386275 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 608 |
| Practice Address |
1010 W Ryan St Brillion WI 54110-1079 |
| Mailing Address |
1010 W Ryan St Brillion WI 54110-0000 |
| Practice Telephone | 9204294243 |
| Practice Fax Number | 9207569262 |
| Mailing Telephone | 9207562640 |
| Mailing Fax Number | 9207569262 |
| Enumeration Date | 2011-08-03 |
| Last Update Date | 2012-02-08 |
| 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 | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers | ||
| 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 |
|---|---|---|---|
| WI | 1922386275 | 05 |
| Other Name | Type Code |
|---|---|
| ShopKo Pharmacy 608 | 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 |
1010 W RYAN ST |
| City | BRILLION |
| State | WI |
| Zip Code | 54110-1079 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164618013 | Mark Alan Rysticken | Pharmacist | 1010 W Ryan St, Brillion, WI 54110-1079 | 2007-09-24 |
| 1730421710 | Michael J Micksch | Pharmacist | 1010 W Ryan St, Brillion, WI 54110-1079 | 2013-03-18 |
| 1376821629 | Shopko Stores Operating Co LLC | Eyewear Supplier (Equipment, not the service) | 1010 W Ryan St, Brillion, WI 54110-0000 | 2011-08-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427691096 | Richelle L. Bruette | Technician | 306a Lavesta Ct., Brillion, WI 54110 | 2019-10-25 |
| 1659913614 | Emily M. Rataichek | Technician | 306a La Vesta Ct., Brillion, WI 54110 | 2019-10-11 |
| 1548457757 | Community Eyecare Inc | Optometrist | 950 W Ryan St, Suite A, Brillion, WI 54110 | 2007-10-02 |
| 1629120589 | Jeffery S Wierichs | Chiropractor | 114 N Main Street, Brillion, WI 54110 | 2007-01-18 |
| 1154478469 | Ascension Medical Group-fox Valley Wisconsin, Inc | Durable Medical Equipment & Medical Supplies | 708 W. Ryan St., Brillion, WI 54110 | 2007-01-05 |
| 1659377828 | Kanwar Arora | Internal Medicine | 133 Wisconsin Ave, Brillion, WI 54110 | 2005-06-22 |
| 1679729834 | Bel-regional Home Medical Inc | Eyewear Supplier (Equipment, not the service) | 964 W Ryan St, Suite E, Brillion, WI 54110 | 2008-08-07 |
| 1306004692 | Ascension Medical Group-fox Valley Wisconsin, Inc | Clinic/Center | 708 W Ryan St, Brillion, WI 54110 | 2008-05-23 |
| 1891963112 | Bellin Memorial Hospital Inc | Optometrist | 964 W Ryan St, Suite E, Brillion, WI 54110 | 2008-02-20 |
| 1104978055 | T.j. Kalies | Chiropractor | 114 N Main Street, Brillion, WI 54110 | 2007-01-18 |
| Find all providers in zip 54110 | ||||
| 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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| 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 | ||||
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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.