SHOPKO STORES OPERATING CO LLC (NPI# 1609829464) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609829464 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 017 |
| Practice Address |
4161 2nd St S Saint Cloud MN 56301-3761 |
| Practice Telephone | 3202533280 |
| Practice Fax Number | 3202535790 |
| Mailing Telephone | 3202533280 |
| Mailing Fax Number | 3202535790 |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2014-05-22 |
| 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 |
2627960 | MN | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 0154160058 | 05 | |
| NCPDP NUMBER | 2414249 | 01 | |
| MN | 606234200 | 05 | |
| MN | 625857300 | 05 | |
| MN | 578612000 | 05 |
| Other Name | Type Code |
|---|---|
| ShopKo Pharmacy 017 | 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 |
4161 2ND ST S |
| City | SAINT CLOUD |
| State | MN |
| Zip Code | 56301-3761 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174575500 | Shopko Stores Operating Co. LLC | Eyewear Supplier (Equipment, not the service) | 4161 2nd St S, Saint Cloud, MN 56301-3761 | 2006-05-16 |
| 1427476241 | Michael Neuwirth | Pharmacist | 4161 2nd St S, Saint Cloud, MN 56301-3761 | 2014-03-29 |
| 1134546211 | Leslie Kiel | Pharmacist | 4161 2nd St S, Saint Cloud, MN 56301-3761 | 2014-03-26 |
| 1013154202 | Lori Ann Keppers | Pharmacist | 4161 2nd St S, Saint Cloud, MN 56301-3761 | 2009-01-10 |
| 1881634806 | Bryan David Lorenz | Optometrist | 4161 2nd St S, Shopko Optical, Saint Cloud, MN 56301-3761 | 2006-06-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013528207 | Stephen Sean Jenkins | Psychologist | 720 Fourth Ave. S., Eastman Hall 305, Saint Cloud, MN 56301 | 2020-08-12 |
| 1316453442 | Amber Grengs | Behavior Technician | 3721 23rd St S Ste 201, Saint Cloud, MN 56301 | 2017-12-27 |
| 1124532999 | Ashley Aune Lewandowski | Chiropractor | 3333 W. Division St. Suite 122a, St. Cloud, MN 56301 | 2017-11-30 |
| 1962923680 | Inspired By You Home Care, LLC | Home Health | 2700 1st Street N, Suite 202, St Cloud, MN 56301 | 2017-07-03 |
| 1487189569 | Brett Finberg | Pharmacy Technician | 141 33rd Ave South, Saint Cloud, MN 56301 | 2017-04-26 |
| 1629513221 | Robert Schug | Pharmacy Technician | 141 33rd Ave S, Saint Cloud, MN 56301 | 2017-01-05 |
| 1649726910 | Rebecca Hoffman Pllc | Specialist | 3400 1st Street N, Suite 300, St. Cloud, MN 56301 | 2016-08-28 |
| 1558728600 | Language Partners | Interpreter | 400 1st St S, Suite 600, St. Cloud, MN 56301 | 2016-01-20 |
| 1679981856 | Quality Homecare Services Inc | Home Health | 3450 W Germain St, Ste 206, St Cloud, MN 56301 | 2014-07-31 |
| 1063759546 | Grand St Paul Cvs, LLC | Durable Medical Equipment & Medical Supplies | 2420 Division St, St. Cloud, MN 56301 | 2013-01-03 |
| Find all providers in zip 56301 | ||||
| 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 |
|---|---|---|---|---|
| 1487117792 | Costco Wholesale Corporation | Pharmacy | 3636 2nd St S, Saint Cloud, MN 56301-3732 | 2019-04-12 |
| 1235447723 | Walgreen Co | Pharmacy | 251 County Road 120 Ste 101, Saint Cloud, MN 56303-4886 | 2010-09-17 |
| 1396067468 | Coborns Inc | Pharmacy | 250 33rd Ave S, Saint Cloud, MN 56301-6131 | 2010-02-17 |
| 1750485660 | Holiday Cvs LLC | Pharmacy | 2101 13th St, Saint Cloud, FL 34769-4206 | 2006-09-12 |
| 1124122015 | Holiday Cvs LLC | Pharmacy | 3555 13th St, Saint Cloud, FL 34769-4054 | 2006-09-12 |
| 1326053638 | Walgreen Co | Pharmacy | 2505 W Division St, Saint Cloud, MN 56301-3837 | 2006-07-29 |
| 1689696361 | Grand St Paul Cvs LLC | Pharmacy | 4201 W Division St, Saint Cloud, MN 56301-6601 | 2006-07-24 |
| 1861036592 | Keshav Rx LLC | Pharmacy | 520 13th St, Saint Cloud, FL 34769-4531 | 2019-11-06 |
| 1205328663 | St.cloud Pharmacy&wellness Center | Pharmacy | 2801 13th St, Saint Cloud, FL 34769-4134 | 2018-06-01 |
| 1194897868 | Coborns Inc | Pharmacy | 2118 8th St N, Saint Cloud, MN 56303-6150 | 2006-11-15 |
| Find all providers in SAINT CLOUD | ||||
| City | SAINT CLOUD |
| Zip Code | 56301 |
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.