SHOPKO STORES OPERATING CO LLC (NPI# 1215108758) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215108758 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 698 |
| Practice Address |
718 4th Street Gothenburg NE 69138 |
| Mailing Address |
718 4th Street Po Box 254 Gothenburg NE 69138 |
| Practice Telephone | 3085378780 |
| Practice Fax Number | 3085374309 |
| Mailing Telephone | 3085378780 |
| Mailing Fax Number | 3085374309 |
| Enumeration Date | 2008-03-12 |
| Last Update Date | 2012-12-27 |
| 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 | 333600000X | Pharmacy | Suppliers | ||
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NE | 10025618100 | 05 |
| Other Name | Type Code |
|---|---|
| Shopko Pharmacy 698 | 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 |
718 4TH STREET |
| City | GOTHENBURG |
| State | NE |
| Zip Code | 69138 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215235023 | Gottenburg Senior Living, LLC | Assisted Living Facility | 110 20th Street, Gothenburg, NE 69138 | 2011-03-02 |
| 1013047810 | Randal E Strohmyer | Dentist | 513 10th Street, Gothenburg, NE 69138 | 2007-03-07 |
| 1225177652 | Brenda Hiebner | Counselor | 815 Lake Ave, Gothenburg, NE 69138 | 2007-02-05 |
| 1790887917 | Royce Lydell Hiebner | Chiropractor | 417 9th St, Gothenburg, NE 69138 | 2006-09-01 |
| 1649652306 | Kayla S Knauss | Family Medicine | 918 20th St, Gothenburg, NE 69138 | 2015-06-18 |
| 1427499854 | Wendy Hunt Most | Counselor | 41190 Road 768, Gothenburg, NE 69138-1189 | 2013-07-14 |
| 1588022180 | Life Transitions LLC | Counselor | 41190 Road 768, Gothenburg, NE 69138-1189 | 2016-02-10 |
| 1871566695 | Garret T Shaw | Family Medicine | 918 20th St, Gothenburg, NE 69138-1237 | 2006-02-10 |
| 1750352480 | Amy S Mahar | Physician Assistant | 918 20th Street, Gothenburg, NE 69138-1237 | 2006-01-31 |
| 1962059766 | Gothenburg Memorial Hospital | Family Medicine | 918 20th St, Gothenburg, NE 69138-1237 | 2019-08-26 |
| Find all providers in zip 69138 | ||||
| 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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| 1952960783 | Lincoln Pharmacy LLC | Pharmacy | 3300 A Street, Ste 100, Lincoln, NE 68510-4512 | 2019-06-06 |
| 1457819922 | Providence Medical Center | Pharmacy | 803 Providence Rd Ste 101, Wayne, NE 68787-1590 | 2019-03-04 |
| 1801374491 | Walnut Creek LLC | Pharmacy | 11020 Q Street, Omaha, NE 68137 | 2018-08-06 |
| 1992283584 | Rainwood Rx LLC | Pharmacy | 20513 Nicholas Circle, Ste 3, Elkhorn, NE 68022 | 2018-08-06 |
| 1083128250 | Innovative Pain & Spine Specialists | Pharmacy | 7121 Stephanie Ln Ste 104, Lincoln, NE 68516-5359 | 2017-11-27 |
| 1225547433 | Costco Wholesale Corportation | Pharmacy | 1620 Pine Lake Road, Lincoln, NE 68512 | 2017-09-20 |
| 1699191734 | Arborpharm, LLC | Pharmacy | 203 S 7th St, Ste B, Wymore, NE 68466 | 2014-03-13 |
| 1982020590 | B&r Stores, Inc | Pharmacy | 611 N Burlington Ave, Hastings, NE 68901-5037 | 2014-03-07 |
| Find all providers with the same taxonomy | ||||
| City | GOTHENBURG |
| Zip Code | 69138 |
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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.