SHOPKO #602 (NPI# 1265878110) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265878110 |
| Entity Type | Organization |
| Organization Name | SHOPKO #602 |
| Practice Address |
126 Charles St Oconto WI 54153-9446 |
| Practice Telephone | 9208345251 |
| Practice Fax Number | 9208349801 |
| Mailing Telephone | 9208345251 |
| Mailing Fax Number | 9208349801 |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2013-05-20 |
| Authorized Official Name | MR. NICK JACKSON JR. (PHARMACY MANAGER) |
| Authorized Official Telephone | 9208345251 |
| Authorized Official Credential | R.PH. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 333600000X | Pharmacy | 900542 | WI | Suppliers |
| Street Address |
126 CHARLES ST |
| City | OCONTO |
| State | WI |
| Zip Code | 54153-9446 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982922860 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 126 Charles St, Oconto, WI 54153-9446 | 2010-05-17 |
| 1194155267 | Thomas Lotter Sr. | Pharmacist | 126 Charles St, Oconto, WI 54153-9446 | 2013-11-26 |
| 1154617652 | Jaclyn Ann Keller | Optometrist | 126 Charles St, Oconto, WI 54153-9446 | 2011-06-22 |
| 1346569183 | Shopko Stores Operating Co LLC | Eyewear Supplier (Equipment, not the service) | 126 Charles St, Oconto, WI 54153-9446 | 2010-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629240650 | Aurora Medical Group Inc | Durable Medical Equipment & Medical Supplies | 530 Smith Ave, Oconto, WI 54153 | 2008-03-31 |
| 1912997081 | Benzer Wi 1 LLC | Pharmacy | 1008 Main St, Oconto, WI 54153 | 2005-10-28 |
| 1245758127 | Hayley Joy Maxwell | Counselor | 501 Park Ave, Oconto, WI 54153 | 2017-08-31 |
| 1538542089 | Aliaksandr Trusau | Internal Medicine | 620 Smith Ave, Oconto, WI 54153 | 2015-07-01 |
| 1467879296 | Christopher Hanke | Counselor | 501 Park Ave, Oconto, WI 54153 | 2014-03-18 |
| 1669807020 | Joshua Ammon Weenig | Dentist | 1210 Pecor St, Oconto, WI 54153 | 2013-09-04 |
| 1609050798 | Bellin Psychiatric Center Inc | Clinic/Center | 820 Arbutus Ave, Oconto, WI 54153 | 2007-12-26 |
| 1932252533 | Oconto County Health & Human Services | Registered Nurse | 501 Park Ave, Oconto, WI 54153 | 2007-01-19 |
| 1841343449 | Oconto County Health & Human Services | Hospice Care, Community Based | 501 Park Ave, Oconto, WI 54153 | 2007-01-19 |
| 1457425951 | Lori Jo Eklund Walsh | Counselor | 820 Arbutus Ave, Oconto, WI 54153 | 2006-11-17 |
| Find all providers in zip 54153 | ||||
| Taxonomy Code | 333600000X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. |
| 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: added definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912997081 | Benzer Wi 1 LLC | Pharmacy | 1008 Main St, Oconto, WI 54153 | 2005-10-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497355002 | Long Life Pharmacy 2 LLC | Pharmacy | 1225 W Historic Mitchell St Ste 217, Milwaukee, WI 53204-3382 | 2020-11-01 |
| 1710527783 | Sage Specialty Pharmacy Inc. | Pharmacy | 4001 N. Oakland Ave, Shorewood, WI 53211 | 2020-01-08 |
| 1790333623 | Froedtert Health Pharmacy LLC | Pharmacy | 9200 W Wisconsin Ave Ste 200w, Milwaukee, WI 53226-3522 | 2019-09-04 |
| 1225686405 | Froedtert Health Pharmacy LLC | Pharmacy | 9200 W Wisconsin Ave Ste 200c, Milwaukee, WI 53226-3522 | 2019-08-30 |
| 1134777337 | Froedtert Health Pharmacy LLC | Pharmacy | 11430 N Port Washington Rd Ste 103, Mequon, WI 53092-3414 | 2019-08-30 |
| 1619524766 | University Rx LLC | Pharmacy | 133 E College Ave, Appleton, WI 54911 | 2019-08-23 |
| 1053967026 | Accurabenefits, LLC | Pharmacy | 2413 Woodland Ter, Neenah, WI 54956-4824 | 2019-08-14 |
| 1184276917 | St. Clare Health Mission Pharmacy | Pharmacy | 916 Ferry St, La Crosse, WI 54601-4717 | 2019-07-11 |
| 1851851141 | Dean Retail Services, Inc. | Pharmacy | 740 Reena Ave Ste 300, Fort Atkinson, WI 53538-3145 | 2019-03-22 |
| 1093287237 | Del Mar Pharmacy Sc | Pharmacy | 1000 S Cesar E Chavez Dr, Milwaukee, WI 53204-2203 | 2018-12-28 |
| Find all providers with the same taxonomy | ||||
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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.