SHOPKO STORES OPERATING CO LLC (NPI# 1316976558) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316976558 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 640 |
| Practice Address |
700 Progress Blvd Tuscola IL 61953-2070 |
| Practice Telephone | 2172535123 |
| Practice Fax Number | 2172535124 |
| Mailing Telephone | 2172535123 |
| Mailing Fax Number | 2172535124 |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2012-09-07 |
| Authorized Official Name | MR. MICHAEL BETTIGA (EXECUTIVE VICE PRESIDENT & 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 |
|---|---|---|---|
| MEDICARE ID - TYPE UNSPECIFIED | 0459230088 | 01 |
| Other Name | Type Code |
|---|---|
| Shopko Pharmacy 640 | 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 |
700 PROGRESS BLVD |
| City | TUSCOLA |
| State | IL |
| Zip Code | 61953-2070 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336545581 | Paul H. Byron | Hearing Instrument Specialist | 602 E. Southline Road, Audibel Hearing Aids, Tuscola, IL 61953 | 2014-11-17 |
| 1679851232 | Beth Ann Wiessing | Speech-Language Pathologist | 1601 East County Road 850 North, Tuscola, IL 61953 | 2011-08-01 |
| 1538356480 | Bart M Tate | Physical Therapist | 301 East Southline Rd, Tuscola, IL 61953 | 2007-09-25 |
| 1972724979 | Kimberly B Whitaker | Family Medicine | 1100 Tuscola Blvd, Sbl Tuscola Clinic, Tuscola, IL 61953 | 2007-05-01 |
| 1396856688 | Tuscola Pain & Wellness Center Sc | Chiropractor | 902 S Court Suite 2, Tuscola, IL 61953 | 2006-08-31 |
| 1225089626 | Nathan L Roberts | Family Medicine | 301 E. Southline Road, Tuscola, IL 61953 | 2006-05-12 |
| 1326008137 | Jamison T Boyd | Optometrist | 902 S Court St, Suite #1, Tuscola, IL 61953 | 2006-03-24 |
| 1629405907 | Ashley K Tennill | Nurse Practitioner | 1100 Tuscola Blvd, Sbl Tuscola Walk In Clinic, Tuscola, IL 61953 | 2013-10-02 |
| 1487892865 | Swarnalatha Jaliparthi | Family Medicine | 301 E. Southline Road, Tuscola, IL 61953 | 2009-01-23 |
| 1295834901 | Sally J Salmons | Family Medicine | 301 E. Southline Road, Tuscola, IL 61953 | 2006-09-21 |
| Find all providers in zip 61953 | ||||
| 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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| 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.