SHOPKO STORES OPERATING CO LLC (NPI# 1174941231) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174941231 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 716 |
| Practice Address |
1520 W 9th St Mount Carmel IL 62863-2909 |
| Practice Telephone | 6182622475 |
| Mailing Telephone | 6182622475 |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2015-09-04 |
| Authorized Official Name | LORIE NEUMANN (VP RETAIL HEALTH SERVICES) |
| Authorized Official Telephone | 9204294726 |
| 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 |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | RAIL ROAD MEDICARE | P00836438 | 01 |
| Other Name | Type Code |
|---|---|
| SHOPKO PHARMACY 716 | 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 |
1520 W 9TH ST |
| City | MOUNT CARMEL |
| State | IL |
| Zip Code | 62863-2909 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033252069 | Phillip Pratt Dewolf | Pharmacist | 1520 W 9th St, Mount Carmel, IL 62863-2909 | 2007-02-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295200319 | Beth Marie Fischer | Physician Assistant | 1527 College Dr., Mt. Carmel, IL 62863 | 2018-10-04 |
| 1386194744 | Kayla Marie Wilcox | Physician Assistant | 1527 College Drive, Mt. Carmel, IL 62863 | 2016-10-10 |
| 1144495961 | Karsten B Slater | Family Medicine | 1527 College Dr, Mount Carmel, IL 62863 | 2008-04-23 |
| 1417147760 | Keesha L. Peterson | Speech-Language Pathologist | 1418 College Drive, Physical Medicine Department, Mount Carmel, IL 62863 | 2007-08-01 |
| 1740488139 | Wabash Area Vocational Enterprises, Inc. | Day Training, Developmentally Disabled Services | 1420 West Third Street, Mt. Carmel, IL 62863 | 2007-07-06 |
| 1972649390 | David Ray Miller | Dentist | 325 East 13th Street, Mount Carmel, IL 62863 | 2007-01-30 |
| 1356406748 | Enrique V Bouffard IIi | Radiology | 326 West 3rd St, Mt Carmel, IL 62863 | 2006-12-26 |
| 1417028168 | General Baptist Nursing Home of Illinois | Skilled Nursing Facility | 1320 W. 9th Street, Mt. Carmel, IL 62863 | 2006-11-13 |
| 1316055130 | Richland Radiology Ltd | Clinic/Center | 326 W 3rd Street, Mount Carmel, IL 62863 | 2006-08-29 |
| 1760986392 | Deaconess Specialty Physicians, Inc | Internal Medicine | 1418 College Dr, Mount Carmel, IL 62863 | 2018-03-20 |
| Find all providers in zip 62863 | ||||
| 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 |
|---|---|---|---|---|
| 1730282401 | Highland Park Cvs, L.L.C. | Pharmacy | 915 N Market St, Mount Carmel, IL 62863-1938 | 2006-09-07 |
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| 1982217345 | Costco Wholesale Corporation | Pharmacy | 2002 N. Neil St., Champaign, IL 61820 | 2020-08-26 |
| 1710599485 | Costco Wholesale Corporation | Pharmacy | 16261 S Boulevard Pl, Plainfield, IL 60586-4400 | 2020-08-23 |
| 1982212635 | Grand Pharmacy LLC | Pharmacy | 229 W Grand Ave Ste F, Bensenville, IL 60106-3365 | 2020-07-20 |
| 1871110254 | Illini Clinic Pharmacy Inc | Pharmacy | 103 N Prospect St, Cambridge, IL 61238-1148 | 2020-07-01 |
| 1831716745 | The Project of The Quad Cities | Pharmacy | 1701 River Dr Ste 106, Moline, IL 61265-1384 | 2020-06-26 |
| Find all providers with the same taxonomy | ||||
| City | MOUNT CARMEL |
| Zip Code | 62863 |
Please comment or provide details below to improve the information on SHOPKO STORES OPERATING CO LLC.
| 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.