SHOPKO STORES OPERATING CO LLC (NPI# 1306397773) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306397773 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 509 |
| Practice Address |
2820 Roosevelt Rd Marinette WI 54143 |
| Practice Telephone | 9204294726 |
| Mailing Telephone | 7153306171 |
| Enumeration Date | 2016-10-20 |
| Last Update Date | 2018-04-27 |
| Authorized Official Name | JANNIE DELANE PASCHAL (VP MANAGED CARE) |
| Authorized Official Telephone | 9204294726 |
| 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 |
|---|---|---|---|
| WI | 1306397773 | 05 |
| Other Name | Type Code |
|---|---|
| SHOPKO PHARMACY 509 | 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 |
2820 ROOSEVELT RD |
| City | MARINETTE |
| State | WI |
| Zip Code | 54143 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417944810 | Sandra B Macarthur | Pediatrics | 2820 Roosevelt Rd, Marinette, WI 54143-3834 | 2005-09-30 |
| 1699393983 | Andrea Olson | Physical Therapist | 2820 Roosevelt Rd, Marinette, WI 54143-3834 | 2020-07-13 |
| 1548804370 | Mallory H Krueger | Dietitian, Registered | 2820 Roosevelt Rd, Marinette, WI 54143-3834 | 2019-11-05 |
| 1154813319 | Ashley T Bretl | Physical Therapist | 2820 Roosevelt Rd, Marinette, WI 54143-3834 | 2018-06-04 |
| 1144725409 | Oconto Hospital & Medical Center, Inc. | Clinic/Center | 2820 Roosevelt Rd, Marinette, WI 54143-3834 | 2018-03-28 |
| 1801307061 | Baycare Clinic, LLP | Neurological Surgery | 2820 Roosevelt Rd, Marinette, WI 54143-3834 | 2017-10-16 |
| 1972013985 | Emily Hope Bauman | Dietitian, Registered | 2820 Roosevelt Rd, Marinette, WI 54143-3834 | 2017-10-04 |
| 1326565334 | Stacie Marie Zdroik | Nurse Practitioner | 2820 Roosevelt Rd, Marinette, WI 54143-3834 | 2017-08-30 |
| 1821527821 | Lucas A Navrestad | Physical Therapist | 2820 Roosevelt Rd, Marinette, WI 54143-3834 | 2017-06-05 |
| 1710415799 | Andrew R Rosik | Physical Therapist | 2820 Roosevelt Rd, Marinette, WI 54143-3834 | 2017-06-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669966750 | Allie Parthie | Dentist | 1420 University Dr, Marinette, WI 54143 | 2018-06-21 |
| 1043730690 | Jonathan Weseman | Emergency Medicine | 3003 University Dr, Marinette, Marinette, WI 54143 | 2017-06-25 |
| 1538698618 | Meghan M Russell | Nurse Practitioner | 4061 Old Peshtigo Road, Marinette, WI 54143 | 2017-06-12 |
| 1801279435 | Stephanie Miller | Licensed Practical Nurse | W1902 State Hwy 64, Marinette, WI 54143 | 2015-07-01 |
| 1417298704 | Danielle Risner | Occupational Therapist | Luther Home 831 Pine Beach Rd, Marinette, WI 54143 | 2013-03-12 |
| 1053631903 | Lincare Inc. | Durable Medical Equipment & Medical Supplies | W 716 County B, Ste B, Marinette, WI 54143 | 2010-06-02 |
| 1417105545 | Forefront Dermatology, S.c. | Dermatology | 3515 Murray Street, Marinette, WI 54143 | 2008-09-03 |
| 1245493352 | Judith M Ribbens | Counselor | 1557 Cleveland Ave, Marinette, WI 54143 | 2008-07-08 |
| 1538338926 | Charlene Mae Miller | Licensed Practical Nurse | 1126 Daggett, Marinette, WI 54143 | 2008-02-29 |
| 1104025519 | James Alan Boren | Family Medicine | 5926 Highway 41, Stephenson, MI 54143 | 2007-07-16 |
| Find all providers in zip 54143 | ||||
| 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 |
|---|---|---|---|---|
| 1811004872 | Bay Area Medical Center Inc | Pharmacy | 3100 Shore Dr-, Suite Cos, Marinette, WI 54143-4242 | 2006-08-24 |
| 1487688602 | Aurora Pharmacy Inc | Pharmacy | 4061 Old Peshtigo Rd, Marinette, WI 54143 | 2006-07-11 |
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|---|---|---|---|---|
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| 1902417207 | Ipack Pharmacy LLC | Pharmacy | 17000 W North Ave Ste 108w, Brookfield, WI 53005-4423 | 2020-08-11 |
| 1851939037 | Ascension Wisconsin Pharmacy, Inc | Pharmacy | 10180 Washington Ave Ste 102, Mount Pleasant, WI 53177-1604 | 2019-12-18 |
| 1558906354 | Life Change Rx 4 LLC | Pharmacy | 6300 N 76th St Ste 246, Milwaukee, WI 53218-1208 | 2019-11-15 |
| 1285278978 | Life Change Rx 3 LLC | Pharmacy | 7115 W Capitol Dr, Milwaukee, WI 53216-2051 | 2019-11-05 |
| 1295377703 | Hayat Pharmacy 21 LLC. | Pharmacy | 2333 Northwestern Ave Ste 120, Racine, WI 53404-2520 | 2019-10-16 |
| 1487296737 | Xperience Pharmacy LLC | Pharmacy | 5715 W Appleton Ave, Milwaukee, WI 53210-2250 | 2019-10-08 |
| 1962053421 | Hayat Pharmacy 19 LLC | Pharmacy | 805 W. Layton Ave. Suite A, Milwaukee, WI 53221 | 2019-09-26 |
| 1275182925 | Walgreen Co | Pharmacy | 2265 N Mayfair Rd, Wauwatosa, WI 53226-2207 | 2019-09-05 |
| 1982257200 | Hayat Pharmacy 16 LLC | Pharmacy | 603 N 36th St, Milwaukee, WI 53208-3826 | 2019-07-17 |
| 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.