SHOPKO STORES OPERATING CO LLC (NPI# 1407044621) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407044621 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 706 |
| Practice Address |
115 Leroux St Doniphan MO 63935-1038 |
| Practice Telephone | 5739962311 |
| Practice Fax Number | 5739967415 |
| Mailing Telephone | 5739962311 |
| Mailing Fax Number | 5739967415 |
| Enumeration Date | 2007-10-12 |
| Last Update Date | 2012-07-31 |
| Authorized Official Name | MR. MICHAEL BETTIGA (EXECUTIVE VICE PRESIDENT & COO) |
| Authorized Official Telephone | 9204294297 |
| 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 |
| Other Name | Type Code |
|---|---|
| Shopko Pharmacy 706 | 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 |
115 LEROUX ST |
| City | DONIPHAN |
| State | MO |
| Zip Code | 63935-1038 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235647629 | Reorganized School Dist 4 | Local Education Agency (LEA) | Hcr 7, Box 51, Doniphan, MO 63935 | 2018-01-19 |
| 1144737206 | Amy Jo Harris | Licensed Practical Nurse | 209 W Highway St, Doniphan, MO 63935 | 2018-01-10 |
| 1518470970 | Freds of Doniphan Inc | Pharmacy | 100 H&s Drive, Doniphan, MO 63935 | 2017-11-08 |
| 1053706390 | Amazing In Home Services, LLC | In Home Supportive Care | 106 Lafayette Street, Doniphan, MO 63935 | 2015-04-03 |
| 1447649595 | Keshia J Russell | Speech-Language Pathologist | 1002 Elm Street, Doniphan, MO 63935 | 2015-01-13 |
| 1720327596 | Jessica L Eddington | Physical Therapist | 1015 Grand Street, Doniphan, MO 63935 | 2013-02-13 |
| 1700150927 | Ripley County Family Resource Center | Community/Behavioral Health | 204 Summit St., Doniphan, MO 63935 | 2012-03-06 |
| 1205107810 | Ripley County Family Resource Center | Community/Behavioral Health | 204 Summit, Doniphan, MO 63935 | 2012-01-13 |
| 1386825248 | Shopko Stores Operating Co LLC | Pharmacy | 111 Leroux Dr, Doniphan, MO 63935 | 2007-11-20 |
| 1104010081 | American Consumer Directed Services, L.L.C. | Clinic/Center | Rr 3, Box 2199, Doniphan, MO 63935 | 2007-09-04 |
| Find all providers in zip 63935 | ||||
| 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 |
|---|---|---|---|---|
| 1386825248 | Shopko Stores Operating Co LLC | Pharmacy | 111 Leroux Dr, Doniphan, MO 63935 | 2007-11-20 |
| 1225359664 | Premiere Healthcare LLC | Pharmacy | 513 N Grand Ave, Doniphan, MO 63935-1405 | 2010-06-21 |
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| 1760005219 | Meta Pharmacy Solutions | Pharmacy | 108 Triad Ctr W, O Fallon, MO 63366-7541 | 2020-05-19 |
| 1437778172 | Harps Food Stores, Inc | Pharmacy | 707 Specialty Dr, Dexter, MO 63841-2718 | 2020-04-13 |
| 1013540038 | Auburn Pharmacy Inc | Pharmacy | 810 W 35th St Ste 101, Higginsville, MO 64037-1865 | 2020-02-18 |
| 1801428495 | Scpg Missouri LLC | Pharmacy | 501 South Madison Ave, Suite S, Webb City, MO 64870 | 2020-02-11 |
| 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.