SHOPKO STORES OPERATING CO LLC (NPI# 1215988183) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215988183 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 141 |
| Practice Address |
313 N Roosevelt Ave Burlington IA 52601-1757 |
| Practice Telephone | 3197589526 |
| Practice Fax Number | 3197532349 |
| Mailing Telephone | 3197589526 |
| Mailing Fax Number | 3197532349 |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2014-06-06 |
| 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 |
1039 | IA | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IA | 0438150 | 05 | |
| IL | 371110040141 | 05 | |
| NCPDP NUMBER | 1619228 | 01 | |
| IA | 0495143 | 05 |
| Other Name | Type Code |
|---|---|
| ShopKo Pharmacy 141 | 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 |
313 N ROOSEVELT AVE |
| City | BURLINGTON |
| State | IA |
| Zip Code | 52601-1757 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417399890 | Benjamin Tatsunori Iwai | Optometrist | 313 N Roosevelt Ave, Burlington, IA 52601-1757 | 2013-07-25 |
| 1083667406 | Shopko Stores Operating Co. LLC | Eyewear Supplier (Equipment, not the service) | 313 N Roosevelt Ave, Burlington, IA 52601-1757 | 2006-05-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033748017 | Quentin Eugene Hill | Technician | 528 South 7th St, Burlington, IA 52601 | 2020-04-02 |
| 1619320645 | Alisa Nicole Smith | Social Worker | 409 N. 4th St., Burlington, IA 52601 | 2016-07-14 |
| 1568870020 | Denise Reichman | Registered Nurse | 2509 Sunrise Ln, Burlington, IA 52601 | 2014-07-29 |
| 1891131355 | Ainsley Joyce Fedler | Speech-Language Pathologist | 9302 Glenmark Drive, Burlington, IA 52601 | 2013-05-10 |
| 1851640932 | Melissa A Rupp | Optometrist | 1035 Lawrence Drive, Suite 106, Burlington, IA 52601 | 2012-09-05 |
| 1508123068 | Advanced Home Health Care | Home Health | 550 S. Roosevelt, Burlington, IA 52601 | 2012-04-20 |
| 1144591926 | David Eric Johnson | Pharmacist | 201 South Central, Burlington, IA 52601 | 2012-01-25 |
| 1548537525 | Michael James Colgan | Pharmacist | 3245 Agency Street, Burlington, IA 52601 | 2011-11-19 |
| 1881971190 | Elaine Frances Lehman | Counselor | 724 North 3rd St., Burlington, IA 52601 | 2011-11-15 |
| 1992086508 | Jacqueline Gwen Robbins | Counselor | 4715 Sullivan Slough Road, Burlington, IA 52601 | 2011-09-09 |
| Find all providers in zip 52601 | ||||
| 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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| 1386077634 | Three Guys Pharmacy | Pharmacy | 2479 S Church St, Burlington, NC 27215-5201 | 2013-08-09 |
| 1639471386 | Walgreen Co | Pharmacy | 623 S Burlington Blvd, Burlington, WA 98233-2209 | 2010-12-01 |
| 1033344577 | Roundys Supermarkets Inc | Pharmacy | 1008 Milwaukee Ave, Burlington, WI 53105-1362 | 2009-05-28 |
| 1861545972 | Brown & Cole Stores LLC | Pharmacy | 1500 S Burlington Blvd, Burlington, WA 98233-3220 | 2007-01-19 |
| 1154473718 | Rajsita2 Inc | Pharmacy | 1005 Sunset Rd, Burlington, NJ 08016-2251 | 2007-01-16 |
| 1184727869 | North Carolina Cvs Pharmacy LLC | Pharmacy | 2017 W Webb Ave, Burlington, NC 27217-1063 | 2006-09-07 |
| 1043321896 | Maxwell's Pharmacy, Inc. | Pharmacy | 242 Pearl St, Burlington, VT 05401-8532 | 2006-08-31 |
| 1922118561 | Costco Wholesale Corporation | Pharmacy | 1725 S Burlington Blvd, Burlington, WA 98233 | 2006-08-30 |
| 1891800843 | Horens Drug Store | Pharmacy | 130 E Fairhaven Ave, Burlington, WA 98233-1740 | 2006-08-20 |
| Find all providers in BURLINGTON | ||||
| City | BURLINGTON |
| Zip Code | 52601 |
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.