SHOPKO STORES OPERATING CO LLC (NPI# 1316990716) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316990716 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 671 |
| Practice Address |
819 11th Ave Sw Waukon IA 52172-7593 |
| Practice Telephone | 5635683668 |
| Practice Fax Number | 5635683693 |
| Mailing Telephone | 5635683668 |
| Mailing Fax Number | 5635683693 |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2012-10-25 |
| 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 | 333600000X | Pharmacy | Suppliers | ||
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IA | 0174805 | 05 | |
| IA | 0495804 | 05 | |
| NCPDP | 1619343 | 01 |
| Other Name | Type Code |
|---|---|
| Shopko Pharmacy 671 | 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 |
819 11TH AVE SW |
| City | WAUKON |
| State | IA |
| Zip Code | 52172-7593 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235468026 | Amy Christine Pfiffner | Occupational Therapy Assistant | 201 Second Street Sw, Waukon, IA 52172 | 2009-12-08 |
| 1609098185 | Worth Living Inc. | Assisted Living Facility | 209 2nd Ave Sw, Waukon, IA 52172 | 2007-05-03 |
| 1154478857 | Mosaic | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 12 E Main, Suite 102, Waukon, IA 52172 | 2007-01-04 |
| 1124121710 | Linda Sue Carstens | Dentist | 18 1st Ave Nw, Waukon, IA 52172 | 2006-09-07 |
| 1659481752 | Cameron Jon Ochsner | Dentist | 22 E Main, Wankon, IA 52172 | 2006-08-30 |
| 1831144302 | Gundersen Clinic, Ltd. | Durable Medical Equipment & Medical Supplies | 120 2nd Avenue Se, Waukon, IA 52172 | 2006-05-23 |
| 1720173990 | Northeast Iowa Dental Professional Corporation | Dentist | 18 1st Ave Nw, Waukon, IA 52172 | 2006-10-04 |
| 1265472807 | Gundersen Clinic, Ltd. | Optometrist | 120 2nd Avenue Se, Waukon, IA 52172 | 2006-06-08 |
| 1639156987 | Mayo Clinic Health System - Franciscan Medical Center, Inc. | Clinic/Center | 105 East Main Street, Waukon, IA 52172 | 2005-12-28 |
| 1528058062 | David B Schwartz | Hospitalist | 40 1st St Se, Waukon, IA 52172 | 2005-10-26 |
| Find all providers in zip 52172 | ||||
| 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 |
|---|---|---|---|---|
| 1972600542 | Hartig Drug Co Corp | Pharmacy | 21 W Main St, Waukon, IA 52172-1637 | 2006-09-17 |
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|---|---|---|---|---|
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| 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 | ||||
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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.