SHOPKO STORES OPERATING CO LLC (NPI# 1023063294) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023063294 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 008 |
| Practice Address |
1105 E Grand Ave Rothschild WI 54474-1024 |
| Practice Telephone | 7153594251 |
| Practice Fax Number | 7153590145 |
| Mailing Telephone | 7153594251 |
| Mailing Fax Number | 7153590145 |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2014-06-06 |
| 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 | ||
| N | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
8634042 | WI | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 33001000 | 05 | |
| NCPDP NUMBER | 5112913 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Pharmacy 008 | 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 |
1105 E GRAND AVE |
| City | ROTHSCHILD |
| State | WI |
| Zip Code | 54474-1024 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114319795 | Jacie Cihlar | Pharmacist | 1105 E Grand Ave, Rothschild, WI 54474-1024 | 2015-02-19 |
| 1487084232 | Rodney Lee Rogalla | Pharmacist | 1105 E Grand Ave, Rothschild, WI 54474-1024 | 2013-11-14 |
| 1093153868 | Scott John Vanermen | Pharmacist | 1105 E Grand Ave, Rothschild, WI 54474-1024 | 2013-06-13 |
| 1619221371 | Stephanie Michelle Masterson | Pharmacist | 1105 E Grand Ave, Rothschild, WI 54474-1024 | 2012-11-02 |
| 1649497033 | Jody A Osowski | Pharmacist | 1105 E Grand Ave, Rothschild, WI 54474-1024 | 2007-04-19 |
| 1346463114 | Timothy Allen Condon | Pharmacist | 1105 E Grand Ave, Rothschild, WI 54474-1024 | 2007-04-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144271362 | Courtney Lee O'keefe | Optometrist | 1039 E Grand Ave, Rothschild, WI 54474-1022 | 2006-05-12 |
| 1518523034 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1039 E Grand Ave, Rothschild, WI 54474-1022 | 2019-05-10 |
| 1588616692 | Shopko Stores Operating Co. LLC | Eyewear Supplier (Equipment, not the service) | 1039 E Grand Ave, Rothschild, WI 54474-1022 | 2006-05-17 |
| 1609168772 | Nicole M Klatt | Audiologist | 903 Grand Ave Ste C-2, Rothschild, WI 54474-1065 | 2011-05-09 |
| 1326670811 | Winding Creek Audiology & Hearing Aid Care LLC | Audiologist | 903 Grand Ave Ste C-2, Rothschild, WI 54474-1065 | 2020-02-12 |
| 1154577898 | Szmanda Dental Center | Dentist | 24 Brown Blvd, Rothschild, WI 54474-1111 | 2008-08-13 |
| 1245507870 | Glaser Dental | Dentist | 24 Brown Blvd, Rothschild, WI 54474-1111 | 2011-11-28 |
| 1568696581 | Teresa L Cornwell | Registered Nurse | 205 Wood St, Rothschild, WI 54474-1150 | 2009-05-05 |
| 1346712734 | Julie Nelson | Registered Nurse | 306 Wood St, Rothschild, WI 54474-1151 | 2018-12-22 |
| 1619977485 | Village of Rothschild | Ambulance | 211 Grand Ave, Rothschild, WI 54474-1173 | 2005-07-22 |
| Find all providers in zip 54474 | ||||
| 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 |
|---|---|---|---|---|
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| 1871527093 | Aurora Pharmacy Inc | Pharmacy | 10101 Market St Ste D102, Rothschild, WI 54474-7938 | 2006-07-11 |
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| 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 | ||||
| City | ROTHSCHILD |
| Zip Code | 54474 |
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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.