SHOPKO STORES OPERATING CO LLC (NPI# 1023069309) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023069309 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 175 |
| Practice Address |
6845 S 27th St Lincoln NE 68512-4823 |
| Practice Telephone | 4024201199 |
| Practice Fax Number | 4024202926 |
| Mailing Telephone | 4024201199 |
| Mailing Fax Number | 4024202926 |
| Enumeration Date | 2006-05-12 |
| 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 | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| N | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
2708 | NE | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCPDP NUMBER | 2815871 | 01 | |
| NE | 10025414600 | 05 | |
| NE | 41098505456 | 05 |
| Other Name | Type Code |
|---|---|
| ShopKo Pharmacy 175 | 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 |
6845 S 27TH ST |
| City | LINCOLN |
| State | NE |
| Zip Code | 68512-4823 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184646127 | John Neumann Boever | Optometrist | 6845 S 27th St, Lincoln, NE 68512-4823 | 2006-07-25 |
| 1942252465 | Shopko Stores Operating Co. LLC | Eyewear Supplier (Equipment, not the service) | 6845 S 27th St, Lincoln, NE 68512-4823 | 2006-05-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013540673 | Unity Youth & Family Services, LLC | Counselor | 6245 Windhaven Drive, Lincoln, NE 68512 | 2020-02-21 |
| 1568961530 | Japhia Warren | Licensed Practical Nurse | 7001 S. 14th Street, Lincoln, NE 68512 | 2018-02-06 |
| 1225547433 | Costco Wholesale Corportation | Pharmacy | 1620 Pine Lake Road, Lincoln, NE 68512 | 2017-09-20 |
| 1447774427 | Adjusted Life Chiropractic LLC | Chiropractor | 2601 Jamie Ln, Ste 104, Lincoln, NE 68512 | 2017-08-01 |
| 1144740101 | Spencer Norton Brown | Chiropractor | 2600 Jamie Ln, Suite 104, Lincoln, NE 68512 | 2017-06-21 |
| 1669826293 | Shaun Stinson | Dentist | 6835 S. 27th St., Ste 2, Lincoln, NE 68512 | 2016-04-20 |
| 1407100324 | Robert M. Lane | Chiropractor | 1245 Libra Dr., Suite 100, Lincoln, NE 68512 | 2012-10-30 |
| 1689782609 | Lynette S Erickson | Counselor | 5539 S 27th, Suite 101, Lincoln, NE 68512 | 2006-08-29 |
| 1699883561 | Duane E Wade | Physical Therapist | 5633 S 16th St Ste 600, Lincoln, NE 68512 | 2006-08-29 |
| 1548779739 | Costco Wholesale Corportation | Hearing Aid Equipment | 1620 Pine Lake Road, Lincoln, NE 68512 | 2017-09-20 |
| Find all providers in zip 68512 | ||||
| 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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|---|---|---|---|---|
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| 1083128250 | Innovative Pain & Spine Specialists | Pharmacy | 7121 Stephanie Ln Ste 104, Lincoln, NE 68516-5359 | 2017-11-27 |
| 1225547433 | Costco Wholesale Corportation | Pharmacy | 1620 Pine Lake Road, Lincoln, NE 68512 | 2017-09-20 |
| 1558897751 | Harps Food Stores, Inc | Pharmacy | 310 W Pridemore Drive, Lincoln, AR 72744 | 2017-05-08 |
| 1891085486 | Alcona Citizens for Health, Inc. | Pharmacy | 177 N Barlow, Lincoln, MI 48742 | 2011-04-15 |
| 1548576192 | Nebraska Cvs Pharmacy LLC | Pharmacy | 4808 O St, Lincoln, NE 68510-1908 | 2010-08-20 |
| 1831230036 | Nebraska Medical Center | Pharmacy | 550 N. 19th Street, Lincoln, NE 68588 | 2007-02-09 |
| 1194898197 | Four Star Drug of Bethany Inc | Pharmacy | 1340 N 66th St, Lincoln, NE 68505-1822 | 2006-11-16 |
| 1528131521 | Four Star Drug of Lincoln Nebraska Inc | Pharmacy | 1265 S Cotner Blvd, Lincoln, NE 68510-4923 | 2006-11-16 |
| Find all providers in LINCOLN | ||||
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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.