SHOPKO INSTITUTIONAL CARE SERVICES (NPI# 1992007926) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992007926 |
| Entity Type | Organization |
| Organization Name | SHOPKO INSTITUTIONAL CARE SERVICES |
| Practice Address |
700 Pilgrim Way Green Bay WI 54304-5263 |
| Practice Telephone | 9204294218 |
| Practice Fax Number | 9204295218 |
| Mailing Telephone | 9204294218 |
| Mailing Fax Number | 9204295218 |
| Enumeration Date | 2010-11-24 |
| Last Update Date | 2010-12-13 |
| Authorized Official Name | MR. MICHAEL J 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 | ||
| Y | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
Suppliers |
| Street Address |
700 PILGRIM WAY |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54304-5263 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952356644 | Shopko Stores Operating Co. LLC | Eyewear Supplier (Equipment, not the service) | 700 Pilgrim Way, Green Bay, WI 54304-5263 | 2006-05-23 |
| 1316504970 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 700 Pilgrim Way, Green Bay, WI 54304-5263 | 2019-05-20 |
| 1205090990 | Kyle J Klika | Optometrist | 700 Pilgrim Way, Green Bay, WI 54304-5263 | 2008-07-11 |
| 1386841385 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 700 Pilgrim Way, Green Bay, WI 54304-5263 | 2007-07-02 |
| 1518086099 | Shopko Properties, LLC | Eyewear Supplier (Equipment, not the service) | 700 Pilgrim Way, Green Bay, WI 54304-5263 | 2007-03-28 |
| 1649215666 | Shopko Stores, Inc. | Eyewear Supplier (Equipment, not the service) | 700 Pilgrim Way, Green Bay, WI 54304-5263 | 2006-06-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689196255 | Kristen Ashley Haltom | Registered Nurse | 2979 Allied St Suite C, Green Bay, WI 54304 | 2017-07-14 |
| 1649671421 | Heather Marie Novak | Counselor | 2979 Allied St Unit C, Green Bay, WI 54304 | 2014-09-11 |
| 1356777684 | Nathan Weir | Specialist/Technologist | 1265 Lombardi Avenue, Green Bay, WI 54304 | 2013-09-18 |
| 1922349927 | John W Hartman | Internal Medicine | 916 Willard Dr, Suite 200, Green Bay, WI 54304 | 2013-03-15 |
| 1447551379 | Citralina M Haruo | Community Health Worker | 1110 11th Avenue, Green Bay, WI 54304 | 2010-11-09 |
| 1497061352 | Daniel James Gustin | Pharmacist | 1109 Lombardi Ave, Green Bay, WI 54304 | 2010-08-28 |
| 1316259898 | Karen A Detrick | Occupational Therapy Assistant | 1040 Pilgram Way, Woodside Senior Communities, Green Bay, WI 54304 | 2010-07-13 |
| 1861667362 | Planned Parenthood of Wi, Inc | Non-Pharmacy Dispensing Site | 2605 S. Oneida St. Suite 107, Green Bay, WI 54304 | 2008-04-25 |
| 1891967303 | Kimberley M Welk | Marriage & Family Therapist | 926 Willard Dr Ste 136, Green Bay, WI 54304 | 2008-03-25 |
| 1750563698 | Richard Lawrence Beyer | Hearing Instrument Specialist | 2154 S Ridge Rd, Green Bay, WI 54304 | 2007-12-03 |
| Find all providers in zip 54304 | ||||
| Taxonomy Code | 3336L0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Long Term Care Pharmacy |
| A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. |
| 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 |
|---|---|---|---|---|
| 1902371107 | Salvanz Enterprises Inc | Pharmacy | 2673 Lineville Rd, Green Bay, WI 54313-7124 | 2018-10-04 |
| 1497898472 | Streus Pharmacy Inc | Pharmacy | 528 N Monroe Ave, Green Bay, WI 54301-4910 | 2007-02-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922646579 | Medical Health Pharmacy LLC | Pharmacy | 8845 S Greenview Dr Ste 1, Middleton, WI 53562-2562 | 2019-12-13 |
| 1124665336 | Ltc Pharmacy Services, LLC | Pharmacy | 11739 W Bradley Rd, Milwaukee, WI 53224 | 2019-12-06 |
| 1487205944 | Hayat Pharmacy 20 LLC | Pharmacy | 805 W. Layton Ave., Suite B, Milwaukee, WI 53221 | 2019-09-26 |
| 1568015022 | T A Solberg Co Inc | Pharmacy | 232 S Courtney St Stop 3, Rhinelander, WI 54501-3308 | 2019-07-23 |
| 1932679081 | Janesville Hometown Pharmacy LLC | Pharmacy | 21 S Jackson St Ste 100, Janesville, WI 53548-3859 | 2018-12-03 |
| 1962999805 | Guardian Pharmacy of Madison, LLC | Pharmacy | N85 W15882 Appleton Ave, Menomonee Falls, WI 53051-3082 | 2018-04-17 |
| 1164932091 | Mabie Pharmacy, LLC | Pharmacy | 10 Liberty St # 106, Deerfield, WI 53531-9458 | 2017-10-05 |
| 1487101754 | Evergreen Pharmacy LLC | Pharmacy | 10101 W Greenfield Ave, West Allis, WI 53214-3953 | 2016-09-05 |
| 1639548142 | Lynja Inc | Pharmacy | 3215 8th St S Ste 101, Wisconsin Rapids, WI 54494-6564 | 2015-09-15 |
| 1184045106 | Healthdirect Institutional Pharmacy Services Inc | Pharmacy | 1721 Miller St, La Crosse, WI 54601-5217 | 2013-12-17 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on SHOPKO INSTITUTIONAL CARE SERVICES.
| 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.