SHOPKO STORES OPERATING CO LLC (NPI# 1508819376) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508819376 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 062 |
| Practice Address |
301 Northwest Byp Great Falls MT 59404-4125 |
| Practice Telephone | 4067279682 |
| Practice Fax Number | 4067279716 |
| Mailing Telephone | 4067279682 |
| Mailing Fax Number | 4067279716 |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2015-12-21 |
| 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 | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| N | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
1200 | MT | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MT | 0211315 | 05 | |
| MT | 0230486 | 05 | |
| NCPDP NUMBER | 2704218 | 01 | |
| MT | 5607875 | 05 |
| Other Name | Type Code |
|---|---|
| ShopKo Pharmacy 062 | 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 |
301 NORTHWEST BYP |
| City | GREAT FALLS |
| State | MT |
| Zip Code | 59404-4125 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902859515 | Shopko Stores Operating Co. LLC | Technician/Technologist | 301 Northwest Byp, Great Falls, MT 59404-4125 | 2006-05-18 |
| 1255748414 | Colleen Johnson | Pharmacist | 301 Northwest Byp, Great Falls, MT 59404-4125 | 2014-07-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629504154 | Shawna Renee Applegate | Nurse Practitioner | 115 4th St S., Great Falls, MT 59404 | 2017-05-03 |
| 1093267213 | Cara Firman | Counselor | 3300 3rd St Ne, Great Falls, MT 59404 | 2016-11-04 |
| 1457803900 | Benjamin Huempfner | Counselor | 1205 1st Ave Nw, Great Falls, MT 59404 | 2016-11-01 |
| 1649675471 | Stephen Trautman | Pharmacist | 1000 3rd Steet Nw, Great Falls, MT 59404 | 2014-10-22 |
| 1457765851 | Complete Eye Care Pllc | Optometrist | 1012 1st Ave Nw, Great Falls, MT 59404 | 2014-06-13 |
| 1871923714 | William Joshu | Physician Assistant | 25 14th Avenue N.w., Great Falls, MT 59404 | 2013-11-13 |
| 1679839369 | Joelene Sharon (o'neill) Goodover | Counselor | 803 Forest Ave., Great Falls, MT 59404 | 2012-04-06 |
| 1942512728 | Amy Jo Jamieson | Counselor | 600 Ave. A, Valley View School, Great Falls, MT 59404 | 2010-07-08 |
| 1942527890 | Matthew Clayton Taecker | Emergency Medicine | 113 38th Ave Ne, Great Falls, MT 59404 | 2010-04-30 |
| 1720212897 | Dana Marie Thompson | Military Health Care Provider | 819 Rhs/sg, 6944 Goddard Drive, Malmstrom Afb, MT 59404 | 2009-05-05 |
| Find all providers in zip 59404 | ||||
| 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 |
|---|---|---|---|---|
| 1417013582 | Discount Pharmacy Inc. | Pharmacy | 601 10th Ave S, Great Falls, MT 59405-4048 | 2006-12-30 |
| 1982700589 | Apothecary Convenience Pharmacy, Inc. | Pharmacy | 20 3rd St N, Great Falls, MT 59401-3188 | 2006-09-15 |
| 1861055535 | Community Health Care Center Incorporated | Pharmacy | 601 1st Ave N, Great Falls, MT 59401-2510 | 2019-04-18 |
| 1265919351 | Big Sky Managed Care | Pharmacy | 915 1st Ave S Ste 110, Great Falls, MT 59401-3705 | 2018-07-23 |
| 1508318205 | Public Drug Co | Pharmacy | 324 Central Ave, Great Falls, MT 59401-3114 | 2016-10-28 |
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| 1023630662 | Pharm406 Inc | Pharmacy | 1410 38th St W Ste A, Billings, MT 59102-7552 | 2020-05-16 |
| 1710521679 | Billmont Rx, LLC | Pharmacy | 1603 Grand Ave Ste 250, Billings, MT 59102-3000 | 2019-11-04 |
| 1235636689 | Daniel Patrick Doran | Pharmacy | 590 Stockett Rd, Sand Coulee, MT 59472-9745 | 2018-04-11 |
| 1477069193 | 406 Rx Pllc | Pharmacy | 117 N Main St Ste A, Three Forks, MT 59752-9013 | 2017-12-18 |
| 1508385477 | Jkw & Jira Inc. | Pharmacy | 1245 N 29th St Ste 100, Billings, MT 59101 | 2017-09-12 |
| 1326564857 | Billings Clinic Specialty Supplies and Services, LLC | Pharmacy | 1015 Broadwater Ave Ste 101, Billings, MT 59102 | 2017-08-16 |
| 1679977433 | Superior Specialty Pharmacy of Montana, LLC | Pharmacy | 20 Four Mile Dr Ste 4, Kalispell, MT 59901-2644 | 2014-10-22 |
| 1134439797 | Kc Western Drug | Pharmacy | 105 E 1st, Clyde Park, MT 59018-0000 | 2010-10-18 |
| 1669795647 | Broadus Foods, Inc | Pharmacy | 120 S Park Avenue, Broadus, MT 59317-0549 | 2010-03-05 |
| 1316135940 | Rosauers Supermarkets Inc | Pharmacy | 3255 Technology Blvd W, Bozeman, MT 59718-6854 | 2007-10-09 |
| Find all providers with the same taxonomy | ||||
| City | GREAT FALLS |
| Zip Code | 59404 |
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.