SHOPKO INSTITUTIONAL CARE SERVICES CO LLC (NPI# 1053621243) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053621243 |
| Entity Type | Organization |
| Organization Name | SHOPKO INSTITUTIONAL CARE SERVICES CO LLC |
| Other Organization Name | SHOPKO RXCARE |
| Practice Address |
3701 E Evergreen Dr Ste 1000 Appleton WI 54913-7402 |
| Practice Telephone | 9207397855 |
| Practice Fax Number | 9207393922 |
| Mailing Telephone | 9207397855 |
| Mailing Fax Number | 9207393922 |
| Enumeration Date | 2010-10-21 |
| Last Update Date | 2011-11-01 |
| Authorized Official Name | MR. MICHAEL 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 |
9041042 | WI | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 1053621243 | 05 | |
| MI | 1053621243 | 05 |
| Other Name | Type Code |
|---|---|
| Shopko RxCare | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831515766 | Shopko Institutional Care Services Co LLC | Durable Medical Equipment & Medical Supplies | 150 N Patrick Blvd, 250, Brookfield, WI 53045-5892 | 2014-03-17 |
| 1770893968 | Shopko Institutional Care Services Co LLC | Durable Medical Equipment & Medical Supplies | 2704 Industrial Drive, Monona, WI 53713-4806 | 2010-10-21 |
| 1811235781 | Shopko Institutional Care Services Co LLC | Durable Medical Equipment & Medical Supplies | 3184 London Rd, Eau Claire, WI 54701-6834 | 2013-01-28 |
| Street Address |
3701 E EVERGREEN DR STE 1000 |
| City | APPLETON |
| State | WI |
| Zip Code | 54913-7402 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174631634 | Steven J Marcus | Pharmacist | 3701 E Evergreen Dr, Appleton, WI 54913-7402 | 2006-08-26 |
| 1235502881 | Brenda Kovach | Pharmacist | 3701 E Evergreen Dr, Suite 1000, Appleton, WI 54913-7402 | 2015-11-04 |
| 1790157345 | Rachael Averill | Pharmacist | 3701 E Evergreen Dr, Suite 1000, Appleton, WI 54913-7402 | 2015-10-22 |
| 1134520596 | Healthdirect Institutional Pharmacy Services, Inc. | Pharmacy | 3701 E Evergreen Dr, Suite 1000, Appleton, WI 54913-7402 | 2014-09-04 |
| 1235452889 | Tad Schilke | Pharmacist | 3701 E Evergreen Dr, Suite 1000, Appleton, WI 54913-7402 | 2010-03-10 |
| 1356521215 | Ginger Lynn Morrison | Pharmacist | 3701 E Evergreen Dr, Suite 1000, Appleton, WI 54913-7402 | 2007-11-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457994584 | Pamela J Andersen | Music Therapist | 245 N. Metro Drive, Appleton, WI 54913 | 2019-10-22 |
| 1396387510 | Nancy Sibley | Technician | N4423 County Road Ee, Appleton, WI 54913 | 2019-10-09 |
| 1659872240 | Meijer Stores Limited Partnership | Durable Medical Equipment & Medical Supplies | 3801 N. Richmond Street, Grand Chute, WI 54913 | 2018-02-28 |
| 1780116244 | Alison Pelger | Physician Assistant | 3916 North Intertech Court, Appleton, WI 54913 | 2017-04-03 |
| 1316311905 | Lucy Bouressa | Specialist/Technologist | 2105 E. Enterprise Ave, 113, Appleton, WI 54913 | 2015-11-19 |
| 1992189989 | Brittany Reinke | Physical Therapist | Walking and Wheeling, LLC, W4652 Glenn Street, Appleton, WI 54913 | 2015-07-20 |
| 1902280092 | Costco Wholesale Corporation | Pharmacy | 5401 W Integrity Way, Grand Chute, WI 54913 | 2015-07-17 |
| 1942646849 | Richard Anthony Mauthe | Pharmacist | 5401 W. Integrity Way, Neenah, WI 54913 | 2013-05-17 |
| 1750622163 | Tonya Janelle Wilderman | Pharmacist | 1400 N Mccarthy Rd, Apt 2, Grand Chute, WI 54913 | 2013-03-10 |
| 1295938777 | Jenna Marie Kadlec | Physical Therapist | 3916 N. Intertech Court, Appleton, WI 54913 | 2007-06-11 |
| Find all providers in zip 54913 | ||||
| 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] |
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|---|---|---|---|---|
| 1457440133 | Morton Drug Co Inc | Pharmacy | 601 W College Ave, Appleton, WI 54911-5803 | 2006-10-12 |
| 1255747812 | Lewis Family Drug LLC | Pharmacy | 145 N Miles St, Appleton, MN 56208-1316 | 2014-07-03 |
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| 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 |
| 1902371107 | Salvanz Enterprises Inc | Pharmacy | 2673 Lineville Rd, Green Bay, WI 54313-7124 | 2018-10-04 |
| 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 |
| 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.