SHOPKO STORES OPERATING CO LLC (NPI# 1043263825) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043263825 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 2643 |
| Practice Address |
91 Pine Lake Dr Newaygo MI 49337 |
| Practice Telephone | 2316529484 |
| Practice Fax Number | 2316529485 |
| Mailing Telephone | 2316529484 |
| Mailing Fax Number | 2316529485 |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2015-12-14 |
| Authorized Official Name | MR. RUSSELL STEINHORST (SVP AND COO) |
| Authorized Official Telephone | 9204297489 |
| 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 | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCPDP NUMBER | 2361436 | 01 | |
| MI | 2361436 | 05 | |
| MI | 4819210 | 05 | |
| MI | 4913875 | 05 |
| Other Name | Type Code |
|---|---|
| Shopko Pharmacy 2643 | 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 |
91 PINE LAKE DR |
| City | NEWAYGO |
| State | MI |
| Zip Code | 49337 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558907824 | Community Hospice, Inc | Hospice Care, Community Based | 181 West River Valley, Newaygo, MI 49337 | 2019-11-21 |
| 1295289973 | Kayla Rose Smith | Social Worker | 232 E 82nd St., Newaygo, MI 49337 | 2016-08-10 |
| 1952674954 | Herminigilda Dadulia Delantar | Physical Therapist | 211 W Pine Lake Drive, Newaygo, MI 49337 | 2012-02-22 |
| 1194982355 | Gale Ann Beach | Social Worker | 12 W Wood, Newaygo, MI 49337 | 2008-05-16 |
| 1275652224 | Jackie Ann Malsom | Social Worker | 12 West Wood, Newaygo, MI 49337 | 2007-03-29 |
| 1841318755 | Joyce Marie Dykstra | Psychologist | 12 W Wood St, Newaygo, MI 49337 | 2007-03-27 |
| 1689726531 | Ronald Paul Leyder | Dentist | 7166 S Croton Hardy Drive, Newaygo, MI 49337 | 2007-01-18 |
| 1356434849 | Melinda Meendering | Physical Therapist | 194 E 82nd St, Newaygo, MI 49337 | 2006-10-02 |
| 1528168929 | Susan Magee Wente | Advanced Practice Midwife | 116 W Northland Drive, Newaygo, MI 49337 | 2006-09-25 |
| 1447238001 | Dennis Nelson | Dentist | 9132 Mason Drive, Newaygo, MI 49337 | 2006-01-04 |
| Find all providers in zip 49337 | ||||
| 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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| 1821606310 | S&k Pharmacy Inc. | Pharmacy | 1916 Davison Rd, Flint, MI 48506-4423 | 2020-07-21 |
| 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.