SHOPKO STORES OPERATING CO LLC (NPI# 1417903865) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417903865 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 030 |
| Practice Address |
2500 E Us Highway 14 Janesville WI 53545-0309 |
| Practice Telephone | 6087547450 |
| Practice Fax Number | 6087541777 |
| Mailing Telephone | 6087547450 |
| Mailing Fax Number | 6087541777 |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2013-08-27 |
| 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 | ||
| N | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
8637042 | WI | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCPDP NUMBER | 5115325 | 01 | |
| WI | 33025000 | 05 |
| Other Name | Type Code |
|---|---|
| ShopKo Pharmacy 030 | 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 |
2500 E US HIGHWAY 14 |
| City | JANESVILLE |
| State | WI |
| Zip Code | 53545-0309 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841242369 | Jennet Ruth Shepherd | Optometrist | 2500 E Us Highway 14, Janesville, WI 53545-0309 | 2006-05-16 |
| 1033555651 | Jamie L Stokstad | Pharmacist | 2500 E Us Highway 14, Janesville, WI 53545-0309 | 2013-05-22 |
| 1790121317 | Emily Setz Atkins | Pharmacist | 2500 E Us Highway 14, Janesville, WI 53545-0309 | 2013-05-22 |
| 1497707400 | Shopko Stores Operating Co. LLC | Eyewear Supplier (Equipment, not the service) | 2500 E Us Highway 14, Janesville, WI 53545-0309 | 2006-05-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730743816 | Wisteria Lyn Gunnink | Social Worker | 3530 N County Highway F, Janesville, WI 53545 | 2019-04-24 |
| 1730601295 | Selma Mohammedi | Dentist | 1260 Milton Ave Ste 140-150, Janesville, WI 53545 | 2017-07-16 |
| 1205357472 | Andrea Jayne Thompson | Physical Therapist | 3418 N Parker Dr., Janesville, WI 53545 | 2017-06-28 |
| 1639549983 | Sylvia Andrus | Physical Therapy Assistant | 3400 N Country Highway F, Janesville, WI 53545 | 2015-09-30 |
| 1518372564 | Kimberly Ann Bishop | Registered Nurse | 32 E. Racine Street, Suite 150, Janesville, WI 53545 | 2014-06-29 |
| 1679998314 | Quirt Family Dentistry | Dentist | 2201 Humes Road Suite 150, Janesville, WI 53545 | 2014-03-04 |
| 1104163740 | Sarah J Fredricks | Licensed Practical Nurse | 1406 Holiday Drive, Janesville, WI 53545 | 2013-01-15 |
| 1659629335 | Parvin Mesbah | Pharmacist | 2017 Old Humes Road, T-0809, Janesville, WI 53545 | 2012-08-28 |
| 1962797118 | Tiffany Schmidt | Pharmacist | 2017 Humes Road, T-0809, Janesv Ille, WI 53545 | 2011-06-16 |
| 1174817795 | Megan Steiner | Dentist | 1504 Creston Park Drive, Janesville, WI 53545 | 2011-05-31 |
| Find all providers in zip 53545 | ||||
| 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 |
|---|---|---|---|---|
| 1528225422 | Walgreen Co | Pharmacy | 2519 Kettering St, Janesville, WI 53546 | 2008-05-19 |
| 1659473767 | Aurora Pharmacy, Inc. | Pharmacy | 2819 N. Lexington Drive, Janesville, WI 53545 | 2006-09-01 |
| 1992815682 | Dean Retail Services, Inc. | Pharmacy | 3200 East Racine Street, Suite 300, Janesville, WI 53546-2343 | 2006-08-30 |
| 1558376442 | Walgreen Co | Pharmacy | 1717 Milton Ave, Janesville, WI 53545-0884 | 2006-07-29 |
| 1700827672 | Wisconsin Cvs Pharmacy LLC | Pharmacy | 1832 W Court St, Janesville, WI 53548-3418 | 2006-06-09 |
| 1942236724 | Mercy Health System Corporation | Pharmacy | 1000 Mineral Point Ave, Janesville, WI 53548-2940 | 2006-06-24 |
| 1467498857 | Mercy Health System Corporation | Pharmacy | 3524 E Milwaukee St, Janesville, WI 53546-1626 | 2006-06-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942816939 | The Duluth Clinic, Ltd. | Pharmacy | 204 Belknap St, Ste 100, Superior, WI 54880-2964 | 2020-09-16 |
| 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 | ||||
| City | JANESVILLE |
| Zip Code | 53545 |
Please comment or provide details below to improve the information on SHOPKO STORES OPERATING CO LLC.
| 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.