SHOPKO STORES OPERATING CO LLC (NPI# 1407807308) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407807308 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 164 |
| Practice Address |
255 John F Kennedy Rd Dubuque IA 52002-5313 |
| Practice Telephone | 5635835808 |
| Practice Fax Number | 5635835804 |
| Mailing Telephone | 5635835808 |
| Mailing Fax Number | 5635835804 |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2008-08-14 |
| Authorized Official Name | MR. MICHAEL J BETTIGA (SR. VICE PRESIDENT HEALTH SERVICES) |
| 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 |
1070 | IA | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IA | 0181107 | 05 | |
| IL | 410985054164 | 05 | |
| IA | 0495309 | 05 | |
| WI | 33236500 | 05 | |
| NCPDP NUMBER | 1619696 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Pharmacy 164 | 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 |
255 JOHN F KENNEDY RD |
| City | DUBUQUE |
| State | IA |
| Zip Code | 52002-5313 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609256627 | Theresa Mccartney | Optometrist | 255 John F Kennedy Rd, Dubuque, IA 52002-5313 | 2015-06-04 |
| 1518910140 | Shopko Stores Operating Co. LLC | Eyewear Supplier (Equipment, not the service) | 255 John F Kennedy Rd, Dubuque, IA 52002-5313 | 2006-05-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144725193 | Rebecca Marie Fitzpatrick | Pharmacist | 7425 Chavenelle Rd Ste 300, Dubuque, IA 52002 | 2018-03-29 |
| 1598020943 | Steven Matthew Leifker | Dentist | 1645 John F. Kennedy Rd, Dubuque, IA 52002 | 2012-07-11 |
| 1922364280 | Susan A Neuser | Pharmacist | 74 25 Chavenelle Rd, Dubuque, IA 52002 | 2012-04-11 |
| 1720308240 | Yakov S Zagalskiy | Family Medicine | 1500 Associates Drive, Dubuque, IA 52002 | 2010-06-07 |
| 1689904690 | Meryl Rae Welsh | Counselor | 2255 Jkf Road, Dubuque, IA 52002 | 2010-01-14 |
| 1982864047 | Joel Gregory Thielen | Acupuncturist | 1880 Radford Road, Dubuque, IA 52002 | 2008-06-12 |
| 1609052323 | Jason E Meyer Physical Therapy PC | Clinic/Center | 2300 John F Kennedy Rd, Dubuque, IA 52002 | 2008-01-11 |
| 1508053828 | Assisted Living Concepts Inc | Assisted Living Facility | 2700 Matthew John Drive, Dubuque, IA 52002 | 2007-10-01 |
| 1588863252 | Miracle Ear | Audiologist-Hearing Aid Fitter | 555 Jf Kennedy Road, Dubuque, IA 52002 | 2007-07-13 |
| 1639383599 | Michelle Ann Gardner | Optometrist | 808 Wacker Dr, Dubuque, IA 52002 | 2007-05-10 |
| Find all providers in zip 52002 | ||||
| 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 |
|---|---|---|---|---|
| 1356448914 | Hartig Drug Co Corp | Pharmacy | 157 Locust St, Dubuque, IA 52001-7660 | 2006-09-17 |
| 1891892451 | Hartig Drug Co Corp | Pharmacy | 2255 John F Kennedy Rd, Dubuque, IA 52002-2846 | 2006-09-17 |
| 1194380717 | Infocus Pharmacy Services | Pharmacy | 1690 Elm St Ste 200, Dubuque, IA 52001-3686 | 2019-05-08 |
| 1417054776 | Hartig Drug Co Corp | Pharmacy | 2225 Central Ave, Dubuque, IA 52001-3506 | 2006-09-20 |
| 1235236597 | Hartig Drug Co Corp | Pharmacy | 1600 University Ave, Dubuque, IA 52001-5937 | 2006-09-20 |
| 1821010562 | Iowa Cvs Pharmacy LLC | Pharmacy | 3500 Dodge St, Dubuque, IA 52003-5261 | 2006-07-24 |
| 1922034131 | Mercy Family Pharmacy | Pharmacy | 1000 Langworthy St, Dubuque, IA 52001-7313 | 2006-06-23 |
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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.