SHOPKO STORES OPERATING CO LLC (NPI# 1073567558) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073567558 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 732 |
| Practice Address |
3225 10th St E Glencoe MN 55336-3369 |
| Practice Telephone | 3208645026 |
| Practice Fax Number | 3208645194 |
| Mailing Telephone | 3208645026 |
| Mailing Fax Number | 3208645194 |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2012-08-23 |
| Authorized Official Name | MR. MICHAEL BETTIGA (EXECUTIVE VICE PRESIDENT & 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 | ||
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| Other Name | Type Code |
|---|---|
| Shopko Pharmacy 732 | 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 |
3225 10TH ST E |
| City | GLENCOE |
| State | MN |
| Zip Code | 55336-3369 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881012532 | Matthew Kelly | Pharmacist | 3225 10th St E, Glencoe, MN 55336-3369 | 2014-03-31 |
| 1356684245 | Shopko Stores Operating Co LLC | Eyewear Supplier (Equipment, not the service) | 3225 10th St E, Glencoe, MN 55336-3369 | 2013-03-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316429160 | Lisa M Thompson | Speech-Language Pathologist | 2105 Hennepin Avenue North, Glencoe, MN 55336 | 2018-08-29 |
| 1609207943 | Sherry Sue Henkelmann | Respite Care | 7768-160th St., Glencoe, MN 55336 | 2013-12-12 |
| 1528277449 | Kelly Jo Higgins | Pharmacist | 2211 11th St. E., Glencoe, MN 55336 | 2007-05-21 |
| 1124180450 | Randy Robert Johnson | Chiropractor | 1706 East Tenth Street, Gauer Chiropractic Clinic, Glencoe, MN 55336 | 2006-12-14 |
| 1790863751 | Merrill D Nelson | Dentist | 1015 Greeley Ave, Glencoe, MN 55336 | 2006-11-01 |
| 1902982481 | Michelle Marie Quale | Registered Nurse | 1805 Hennepin Ave. North, Glencoe Regional Health Services, Glencoe, MN 55336 | 2006-10-27 |
| 1417912122 | Lee Medical Inc | Durable Medical Equipment & Medical Supplies | 1209 Greeley Avenue, Glencoe, MN 55336 | 2006-04-18 |
| 1154319705 | Kristine Leonard Knudten | Family Medicine | 1805 Hennepin Ave North, Glencoe, MN 55336 | 2005-10-07 |
| 1285120477 | Nicole Nash | Registered Nurse | 1805 Hennepin Ave N, Glencoe, MN 55336 | 2018-07-10 |
| 1841640091 | Rachael Stoebe | Hearing Instrument Specialist | 2915 10th St E, Glencoe, MN 55336 | 2016-06-20 |
| Find all providers in zip 55336 | ||||
| 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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| 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.