SHOPKO (NPI# 1184051948) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184051948 |
| Entity Type | Organization |
| Organization Name | SHOPKO |
| Practice Address |
301 Bay Park Sq Green Bay WI 54304-5104 |
| Practice Telephone | 9204995889 |
| Mailing Telephone | 9204995889 |
| Enumeration Date | 2013-10-10 |
| Last Update Date | 2013-10-10 |
| Authorized Official Name | GENA TRAST (PHARMACIST) |
| Authorized Official Telephone | 9204995889 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
051-039854 | WI | Suppliers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | SHOPKO | 700 Pilgrim Way, Green Bay, WI 54304-5263 |
| Colorado Business Entities | Shopko Foundation, Inc. | 700 Pilgrim Way, Green Bay, WI 54304 |
| Iowa Business Entities | SHOPKO HOLDINGS TARTAN PLACE LLC | 1625 First Avenue Se, Cedar Rapids, IA 52406 |
| Iowa Business Entities | SHOPKO HOLDINGS, LLC | 1625 1st Ave Se, Cedar Rapids, IA 52402 |
| System for Award Management (SAM) Entities | SHOPKO OPTICAL | 700 Pilgrim Way, Green Bay, WI 54304-5263 |
| Oregon Corporations, Companies and Business Names | SHOPKO PLAZA LLC | 3500 Chad Drive Suite 550, Eugene, OR 97408 |
| Washington State Corporations | SHOPKO PROPERTIES, LLC | 700 Pilgrim Way, Green Bay, WI 54304 |
| Washington State Corporations | SHOPKO REAL PROPERTY, LLC | 700 Pilgrim Way, Green Bay, WI 54304 |
| Oregon Corporations, Companies and Business Names | SHOPKO STORES OPERATING CO., LLC | 700 Pilgrim Way, Green Bay, WI 54304 |
| Colorado Business Entities | ShopKo Stores Operating Co., LLC | 700 Pilgrim Way, Green Bay, WI 54304 |
| Street Address |
301 BAY PARK SQ |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54304-5104 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285684662 | Elaine M Smith | Physician Assistant | 301 Bay Park Sq, Green Bay, WI 54304-5104 | 2006-05-10 |
| 1174089528 | Britny L Babler | Nurse Practitioner | 301 Bay Park Sq, Green Bay, WI 54304-5104 | 2019-02-11 |
| 1811349970 | Marissa Leigh Zehren | Nurse Practitioner | 301 Bay Park Sq, Green Bay, WI 54304-5104 | 2016-07-12 |
| 1689080277 | Kris L Barrette | Registered Nurse | 301 Bay Park Sq, Green Bay, WI 54304-5104 | 2014-07-03 |
| 1932521945 | Jeffrey Allen Maurer | Physician Assistant | 301 Bay Park Sq, Green Bay, WI 54304-5104 | 2014-01-09 |
| 1962833301 | Gena Trast | Pharmacist | 301 Bay Park Sq, Green Bay, WI 54304-5104 | 2013-12-11 |
| 1629409099 | Thomas Boucher | Pharmacist | 301 Bay Park Sq, Green Bay, WI 54304-5104 | 2013-12-10 |
| 1558615047 | Alisyn R Baciak | Pharmacist | 301 Bay Park Sq, Green Bay, WI 54304-5104 | 2012-11-05 |
| 1376832451 | Sabrina Rhea Spets | Registered Nurse | 301 Bay Park Sq, Green Bay, WI 54304-5104 | 2011-03-29 |
| 1861641516 | Rachael A Cabral Guevara | Nurse Practitioner | 301 Bay Park Sq, Green Bay, WI 54304-5104 | 2008-09-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689196255 | Kristen Ashley Haltom | Registered Nurse | 2979 Allied St Suite C, Green Bay, WI 54304 | 2017-07-14 |
| 1649671421 | Heather Marie Novak | Counselor | 2979 Allied St Unit C, Green Bay, WI 54304 | 2014-09-11 |
| 1356777684 | Nathan Weir | Specialist/Technologist | 1265 Lombardi Avenue, Green Bay, WI 54304 | 2013-09-18 |
| 1922349927 | John W Hartman | Internal Medicine | 916 Willard Dr, Suite 200, Green Bay, WI 54304 | 2013-03-15 |
| 1447551379 | Citralina M Haruo | Community Health Worker | 1110 11th Avenue, Green Bay, WI 54304 | 2010-11-09 |
| 1497061352 | Daniel James Gustin | Pharmacist | 1109 Lombardi Ave, Green Bay, WI 54304 | 2010-08-28 |
| 1316259898 | Karen A Detrick | Occupational Therapy Assistant | 1040 Pilgram Way, Woodside Senior Communities, Green Bay, WI 54304 | 2010-07-13 |
| 1861667362 | Planned Parenthood of Wi, Inc | Non-Pharmacy Dispensing Site | 2605 S. Oneida St. Suite 107, Green Bay, WI 54304 | 2008-04-25 |
| 1891967303 | Kimberley M Welk | Marriage & Family Therapist | 926 Willard Dr Ste 136, Green Bay, WI 54304 | 2008-03-25 |
| 1750563698 | Richard Lawrence Beyer | Hearing Instrument Specialist | 2154 S Ridge Rd, Green Bay, WI 54304 | 2007-12-03 |
| Find all providers in zip 54304 | ||||
| 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 |
|---|---|---|---|---|
| 1134500226 | Salvanz Enterprises Inc | Pharmacy | 2673 Lineville Road, Green Bay, WI 54313 | 2015-06-15 |
| 1366459307 | Walgreen Co | Pharmacy | 1995 Main St, Green Bay, WI 54302-3920 | 2006-08-02 |
| 1881637056 | Wisconsin Cvs Pharmacy LLC | Pharmacy | 2400 Velp Ave, Green Bay, WI 54303-6534 | 2006-06-14 |
| 1447291315 | Wisconsin Cvs Pharmacy LLC | Pharmacy | 1561 W Mason St, Green Bay, WI 54303-2215 | 2006-06-09 |
| 1265473136 | Wisconsin Cvs Pharmacy LLC | Pharmacy | 2222 S Webster Ave, Green Bay, WI 54301-2100 | 2006-06-09 |
| 1740814987 | David Haynes Betts IIi | Pharmacy | 2470 W Mason St, Green Bay, WI 54303-4711 | 2020-02-26 |
| 1689164725 | Walgreen Co | Pharmacy | 500 E Walnut St, Green Bay, WI 54301 | 2018-05-15 |
| 1235486028 | Bel-regional Home Medical Inc. | Pharmacy | 3263 Eaton Rd, Green Bay, WI 54311-6830 | 2012-08-10 |
| 1891022893 | Roundys Supermarkets Inc | Pharmacy | 1291 Lombardi Access Rd, Green Bay, WI 54304-4046 | 2009-11-11 |
| 1760628655 | Bel-regional Home Medical Inc | Pharmacy | 3263 Eaton Rd, Green Bay, WI 54311-6830 | 2008-12-23 |
| Find all providers in GREEN BAY | ||||
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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.