SHOPKO STORES OPERATING CO LLC (NPI# 1508042425) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508042425 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 527 |
| Practice Address |
190 North Main Thayne WY 83127 |
| Mailing Address |
Po Box 1450 Nw 5891 Minneapolis MN 55485-5891 |
| Practice Telephone | 3078834600 |
| Practice Fax Number | 3078834603 |
| Mailing Telephone | 3078834600 |
| Mailing Fax Number | 3078834603 |
| Enumeration Date | 2008-01-10 |
| Last Update Date | 2012-07-31 |
| 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 |
| Other Name | Type Code |
|---|---|
| Shopko Pharmacy 527 | 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 |
190 NORTH MAIN |
| City | THAYNE |
| State | WY |
| Zip Code | 83127 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962750158 | Shopko Stores Operating Co LLC | Durable Medical Equipment & Medical Supplies | 190 North Main, Thayne, WY 83127-1607 | 2012-08-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063012383 | Susan M. Miner | Nurse Practitioner | 487 N. Main St. #2, Thayne, WY 83127 | 2020-10-27 |
| 1679118160 | Stephan Badgett | Social Worker | 383 N Main St, Thayne, WY 83127 | 2019-11-08 |
| 1629402078 | Kyle C Lancaster | Pharmacist | 118 Peterson Pkwy, Thayne, WY 83127 | 2013-08-21 |
| 1225478894 | Our Valley Pharmacy | Durable Medical Equipment & Medical Supplies | 118 Petersen Pkwy, Thayne, WY 83127 | 2013-06-27 |
| 1073892816 | Jennifer Suzanne Knowlton | Counselor | 383 N Main St, 2nd Floor, Thayne, WY 83127 | 2011-08-10 |
| 1619117348 | Access Hospice Care LLC | Home Health | 102293 Hwy 89, Thayne, WY 83127 | 2009-02-20 |
| 1801034475 | Access Home Care LLC | Home Health | 102293 Hyw 89 S, Thayne, WY 83127 | 2009-02-04 |
| 1528206661 | Scott M. Sessions | Chiropractor | 383 N Main Street, Suite 1, Thayne, WY 83127 | 2009-01-28 |
| 1518121748 | Sandra Marcoccia Sears | Social Worker | 624 Alpine Way, Star Valley Ranch, WY 83127 | 2008-07-16 |
| 1093984510 | Alliance Hospice of Star Valley | Hospice Care, Community Based | 63 Bridger Dr, Thayne, WY 83127 | 2008-02-28 |
| Find all providers in zip 83127 | ||||
| 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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| 1285140376 | Bear Lake Community Health Center | Pharmacy | 75 Yellow Creek Rd Ste 102, Evanston, WY 82930-5205 | 2017-12-27 |
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| 1952823783 | Teton County Hospital District | Pharmacy | 555 E Broadway Ave Ste 212, Jackson, WY 83001-8640 | 2017-07-13 |
| 1487047122 | Glenrock Hsopital District | Pharmacy | 925 West Birch, Glenrock, WY 82637-0786 | 2015-03-05 |
| 1619386901 | Kmart Pharmacy | Pharmacy | 4000 East 2nd, Casper, WY 82609 | 2014-08-12 |
| 1235402132 | Afton Family Pharmacy | Pharmacy | 141 N Washington St, Afton, WY 83110 | 2012-02-23 |
| 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.