SHOPKO STORES OPERATING CO LLC (NPI# 1235176983) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235176983 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 169 |
| Practice Address |
3499 E Fairview Ave Meridian ID 83642-5848 |
| Practice Telephone | 2088841286 |
| Practice Fax Number | 2088841186 |
| Mailing Telephone | 2088841286 |
| Mailing Fax Number | 2088841186 |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2009-07-10 |
| 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 | 333600000X | Pharmacy | 2038CP | ID | Suppliers |
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
2038CP | ID | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 805516800 | 05 | |
| NCPDP NUMBER | 1306807 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Pharmacy 169 | 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 |
3499 E FAIRVIEW AVE |
| City | MERIDIAN |
| State | ID |
| Zip Code | 83642-5848 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356393623 | David J Slagowski | Optometrist | 3499 E Fairview Ave, Meridian, ID 83642-5848 | 2006-05-16 |
| 1154989440 | Tyler Callahan | Pharmacy Technician | 3499 E Fairview Ave, Meridian, ID 83642-5848 | 2019-05-31 |
| 1760940084 | Akos Live, LLC | Family Medicine | 3499 E Fairview Ave, Meridian, ID 83642-5848 | 2019-03-05 |
| 1275010357 | Albertsons LLC | Pharmacy | 3499 E Fairview Ave, Meridian, ID 83642-5848 | 2018-07-23 |
| 1073864021 | Janette M Beckwith | Pharmacist | 3499 E Fairview Ave, Meridian, ID 83642-5848 | 2012-09-29 |
| 1225326325 | Kelly Lynn Hancock | Pharmacist | 3499 E Fairview Ave, Meridian, ID 83642-5848 | 2011-07-11 |
| 1841421617 | Flushot4you | Clinical Medical Laboratory | 3499 E Fairview Ave, Meridian, ID 83642-5848 | 2009-07-28 |
| 1184677759 | Shopko Stores Operating Co. LLC | Technician/Technologist | 3499 E Fairview Ave, Meridian, ID 83642-5848 | 2006-05-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174145684 | Ikdo South Meridian LLC | Dentist | 3839 E Amity Rd, Meridian, ID 83642 | 2020-05-07 |
| 1073133328 | Prescription Pad LLC | Pharmacy | 885 S Vanguard Way, Meridian, ID 83642 | 2020-04-16 |
| 1609412683 | Meridian Advanced Psychiatry, LLC | Psychiatry & Neurology | 1672 S Woodsage Ave., Meridan, ID 83642 | 2019-11-25 |
| 1194378927 | Sergey Tsema | Occupational Therapist | 1259 E Pisa St, Meridian, ID 83642 | 2019-07-21 |
| 1003478629 | Chris R Jackson | Dentist | Isu Family Dentistry, 1311 E Central Dr, Meridian, ID 83642 | 2019-07-03 |
| 1285293118 | Morgan Family Medicine | Nurse Practitioner | 1660 S Woodsage Avenue, Meridian, ID 83642 | 2019-06-13 |
| 1033772793 | Nugen Healthcare, Pllc | Registered Nurse | 2177 S Spoonbill Ave, Meridian, ID 83642 | 2019-04-18 |
| 1811471790 | Courtney Crossland | Physician Assistant | 4949 S Hillsdale Ave., Meridian, ID 83642 | 2018-09-18 |
| 1841771938 | Katelyn Perry | Counselor | 2068 S. Eagle Rd., Meridian, ID 83642 | 2018-08-27 |
| 1114406204 | Gem Prep: Meridian LLC | Case Management | 2750 E.gala Ct., Meridian, ID 83642 | 2018-08-09 |
| Find all providers in zip 83642 | ||||
| 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 |
|---|---|---|---|---|
| 1043838584 | Costco Wholesale Corporation | Pharmacy | 3403 W Chinden Blvd, Meridian, ID 83646-7151 | 2020-07-10 |
| 1013559269 | Timberline Pharmacy | Pharmacy | 4574 N Ten Mile Rd Ste 110, Meridian, ID 83646-6930 | 2019-10-09 |
| 1700323599 | Wal-mart Stores East Lp | Pharmacy | 3310-a Highway 39 North, Meridian, MS 39301 | 2017-01-31 |
| 1699048009 | Rosauers Supermarkets Inc | Pharmacy | 2986 N Eagle Rd, Meridian, ID 83646-6251 | 2012-02-15 |
| 1093953218 | Walgreen Co | Pharmacy | 4850 N Linder Rd, Meridian, ID 83646-6159 | 2009-01-26 |
| 1447324967 | Transcript Pharmacy Inc | Pharmacy | 1815 Highway 39 N, Ste E, Meridian, MS 39301-2732 | 2006-11-17 |
| 1417056722 | Mississippi Cvs Pharmacy, L.L.C. | Pharmacy | 820 Highway 19 N Ste 195, Meridian, MS 39307-5820 | 2006-09-22 |
| 1114929296 | Hulls Pharmacy Inc | Pharmacy | 2000 24th Ave, Meridian, MS 39301-3120 | 2005-06-02 |
| 1710525829 | The Family Medicine Residency of Idaho, Inc. | Pharmacy | 2275 S Eagle Rd Ste 120, Meridian, ID 83642-2620 | 2019-12-19 |
| 1609311448 | Freds Stores of Tennessee Inc | Pharmacy | 626 22nd Ave S, Meridian, MS 39301-6120 | 2017-01-04 |
| Find all providers in MERIDIAN | ||||
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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.