SHOPKO STORES OPERATING CO LLC (NPI# 1194776179) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194776179 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 097 |
| Practice Address |
4850 W 3500 S West Valley City UT 84120-2927 |
| Practice Telephone | 8019666500 |
| Practice Fax Number | 8019668805 |
| Mailing Telephone | 8019666500 |
| Mailing Fax Number | 8019668805 |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2013-08-27 |
| Authorized Official Name | MR. MICHAEL J BETTIGA (SR. VICE PRESIDENT HEALTH SERVICES) |
| 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 | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
1320601703 | UT | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCPDP NUMBER | 4606945 | 01 | |
| UT | 410985054151 | 05 |
| Other Name | Type Code |
|---|---|
| ShopKo Pharmacy 097 | 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 |
4850 W 3500 S |
| City | WEST VALLEY CITY |
| State | UT |
| Zip Code | 84120-2927 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114037587 | Steven J Mutchler | Pharmacist | 4850 W 3500 S, West Valley City, UT 84120-2927 | 2006-08-30 |
| 1588617351 | Shopko Stores Operating Co. LLC | Optometrist | 4850 W 3500 S, West Valley City, UT 84120-2927 | 2006-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891349213 | Eli Kenny | Physical Therapist | 336 South 4155 West, West Valley City, UT 84120 | 2019-07-25 |
| 1841765377 | Wan Jen Horng | Pharmacist | 4052 Pioneer Parkway, # 111, West Valley City, UT 84120 | 2018-10-11 |
| 1841784220 | Andrea Savas | Physical Therapist | 3460 South 4155 West, West Valley City, UT 84120 | 2018-06-19 |
| 1235628223 | Meds In Motion, LLC | Pharmacy | 12101 S State St, Suite 101a, Draper, UT 84120 | 2018-05-04 |
| 1316477383 | Kendra Lindsey | Social Worker | 4052 W 3390 S Suite 105, West Valley City, UT 84120 | 2017-06-13 |
| 1154726842 | National Vision, Inc. | Technician/Technologist | 2569 South 5600 West, Ste A 550, West Valley, UT 84120 | 2014-10-24 |
| 1154637825 | Granger Pediatric Dentistry | Clinic/Center | 3725 W. 4100 S., Suite #260, West Valley City, UT 84120 | 2010-08-19 |
| 1104060714 | Comprehensive Medical Management, PC | Physical Medicine & Rehabilitation | 4052 W Pioneer Parkway, Suite 208, West Valley City, UT 84120 | 2009-04-27 |
| 1336384197 | Bamileke Sinju Sinju | Home Health | 3712 South Golden Grain Cir, West Valley City, UT 84120 | 2008-12-09 |
| 1164673331 | Empowered for Life, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5004 West Janette Drive, West Valley City, UT 84120 | 2008-10-07 |
| Find all providers in zip 84120 | ||||
| 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 |
|---|---|---|---|---|
| 1922154756 | Granger Pharmacy | Pharmacy | 2965 W 3500 S, West Valley City, UT 84119-3602 | 2007-01-26 |
| 1295815975 | Davis/burkett Food Corp | Pharmacy | 3765 S 2700 W, West Valley City, UT 84119 | 2006-10-16 |
| 1821014986 | Horng, Inc. | Pharmacy | 4052 Pioneer Pkwy Ste 111, West Valley City, UT 84120-2063 | 2006-07-14 |
| 1740534056 | Granger Pharmacy | Pharmacy | 3725 W 4100 S, West Valley City, UT 84120-5530 | 2012-11-08 |
| 1700119013 | Associated Fresh Markets Inc | Pharmacy | 3555 W 3500 S, West Valley City, UT 84119-2539 | 2009-09-18 |
| 1578761284 | Costco Wholesale Corportation | Pharmacy | 3747 S 2700 W, West Valley City, UT 84119 | 2007-07-03 |
| 1780695338 | Granger Clinic Pharmacy Inc | Pharmacy | 3725 W 4100 S, West Valley City, UT 84120-5530 | 2006-08-10 |
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| 1518577741 | Black Panda LLC | Pharmacy | 2507 S State St, Salt Lake City, UT 84115-3109 | 2020-08-03 |
| 1235751900 | Roe Rx Inc | Pharmacy | 145 S 3000 W, West Point, UT 84015 | 2020-05-15 |
| 1023637675 | Santaquin Market, Inc. | Pharmacy | 110 N. 400 E., Santaquin, UT 84655 | 2020-04-14 |
| 1891345237 | Strive Pharmacy Utah 1 LLC | Pharmacy | 8928 S State St, Sandy, UT 84070-2246 | 2019-09-17 |
| 1336705755 | Bear Lake Community Health Center | Pharmacy | 517 W 100 N Ste 210, Providence, UT 84332-9826 | 2019-05-10 |
| 1912470246 | Ridley's Family Markets Inc | Pharmacy | 74 S 100 E, Tremonton, UT 84337-1606 | 2019-01-09 |
| 1437620762 | Pthl LLC | Pharmacy | 1890 Bonanza Dr Ste 107, Park City, UT 84060-7217 | 2018-12-16 |
| 1093285785 | Richfield Community Pharmacy LLC | Pharmacy | 440 S Main St Ste B, Richfield, UT 84701-2855 | 2018-11-26 |
| Find all providers with the same taxonomy | ||||
| City | WEST VALLEY CITY |
| Zip Code | 84120 |
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.