SHOPKO STORES OPERATING CO LLC (NPI# 1265485031) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265485031 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 677 |
| Practice Address |
2220 Highway 175 W Onawa IA 51040-0149 |
| Mailing Address |
Po Box 149 Onawa IA 51040-0149 |
| Practice Telephone | 7124239648 |
| Practice Fax Number | 7124239659 |
| Mailing Telephone | 7124239648 |
| Mailing Fax Number | 7124239659 |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2013-01-25 |
| 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 | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IA | 0456939 | 05 | |
| IA | 0495572 | 05 | |
| NE | 10025417800 | 05 | |
| NE | 10025240100 | 05 | |
| NCPDP | 1622249 | 01 |
| Other Name | Type Code |
|---|---|
| Shopko Pharmacy 677 | 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 |
2220 HIGHWAY 175 W |
| City | ONAWA |
| State | IA |
| Zip Code | 51040-0149 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083997811 | Mark Leslie Georgopoulos | Physical Therapy Assistant | 225 15th St., Onawa, IA 51040 | 2011-09-28 |
| 1851889117 | Ashton Marie Pruett | Nurse Practitioner | 1614 Diamond Street Pl, Onawa, IA 51040 | 2018-04-23 |
| 1013437441 | Susan Renee Mclaughlin | General Acute Care Hospital | 1600 Diamond St, Onawa, IA 51040 | 2017-06-27 |
| 1093120826 | Kathryn Moore | Family Medicine | 1614 Diamond Street Pl, Onawa, IA 51040 | 2014-07-01 |
| 1194788620 | Elmwood Care Center LLC | Assisted Living Facility | 222 15th St, Onawa, IA 51040-1025 | 2006-04-07 |
| 1750542296 | Barbara J Parks | Physical Therapy Assistant | 222 15th St, Onawa, IA 51040-1025 | 2008-06-18 |
| 1275705865 | Kathryn L Mosier | Physical Therapy Assistant | 222 15th St, Onawa, IA 51040-1025 | 2008-03-24 |
| 1659566362 | Jocelyn Hinkle | Occupational Therapist | 222 15th St, Onawa, IA 51040-1025 | 2007-09-06 |
| 1396948741 | Vicky Carlson | Physical Therapy Assistant | 222 15th St, Onawa, IA 51040-1025 | 2007-06-05 |
| 1144593252 | Elmwood Pe, LLC | Assisted Living Facility | 190 15th St, Onawa, IA 51040-1071 | 2012-02-21 |
| Find all providers in zip 51040 | ||||
| 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 |
|---|---|---|---|---|
| 1174664809 | Stangel Pharmacy Inc | Pharmacy | 903 Iowa Ave, Onawa, IA 51040-1631 | 2007-02-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013546308 | Hy Vee Inc | Pharmacy | 911 S K Ave, Vinton, IA 52349-1073 | 2020-04-07 |
| 1164050944 | Corridor Pharmacy | Pharmacy | 650 W Cherry St Ste 7, North Liberty, IA 52317-9025 | 2020-03-29 |
| 1932740024 | St Luke's Jones Regional Medical Center | Pharmacy | 1795 Highway 64 E Ste 2, Anamosa, IA 52205-2112 | 2019-10-01 |
| 1316407018 | Harlan Pharmacy, LLC | Pharmacy | 1024 5th St, Harlan, IA 51537-1427 | 2019-03-20 |
| 1306304027 | State University of Iowa | Pharmacy | 1360 N Dodge St Ste 1100, Iowa City, IA 52245-6104 | 2019-03-12 |
| 1265999387 | Bancroft Apothecary Lp | Pharmacy | 106 W Ramsey St, Bancroft, IA 50517-8078 | 2019-02-25 |
| 1023588159 | Mark Oleson | Pharmacy | 1100 Broad Street, Adair, IA 50002 | 2018-12-02 |
| 1598235723 | Cjk Pharmacy, LLC | Pharmacy | 3100 E Ave Nw Ste 102, Cedar Rapids, IA 52405-2962 | 2018-11-30 |
| 1144701582 | Madsen Inc | Pharmacy | 307 2nd. St., Gladbrook, IA 50635-5063 | 2018-08-23 |
| 1376024869 | Hy Vee Inc | Pharmacy | 3285 Crosspark Road, Coralville, IA 52241 | 2018-08-23 |
| Find all providers with the same taxonomy | ||||
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.