SHOPKO STORES OPERATING CO LLC (NPI# 1619155512) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619155512 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 702 |
| Practice Address |
908 E 14th St. Larned KS 67550 |
| Mailing Address |
Po Box 1450 Nw 5891 Minneapolis MN 55485-1450 |
| Practice Telephone | 6202853546 |
| Practice Fax Number | 6202853898 |
| Mailing Telephone | 6202853546 |
| Mailing Fax Number | 6202853898 |
| Enumeration Date | 2008-02-04 |
| Last Update Date | 2012-11-08 |
| 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 |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KS | KS DME | 200389320N | 01 |
| KS | 200389320M | 05 |
| Other Name | Type Code |
|---|---|
| Shopko Pharmacy 702 | 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 |
908 E 14TH ST. |
| City | LARNED |
| State | KS |
| Zip Code | 67550 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427406784 | Amanda Haberman | Specialist/Technologist | 201 E 17th, Larned, KS 67550 | 2016-05-27 |
| 1801920699 | Bernadette Novotny | Physical Therapy Assistant | 1114 W 11 St, Learned, KS 67550 | 2007-03-15 |
| 1871699777 | Luis Alberto Perez | Chiropractor | 313 W 14th, Larned, KS 67550 | 2006-09-16 |
| 1245296821 | Smith Dental Clinic LLC | Dentist | 706 Ft Larnel Ave, Larnel, KS 67550 | 2006-04-24 |
| 1730140716 | Terry D Smith | Dentist | 706 Ft Larned Ave, Box 36, Larned, KS 67550 | 2006-03-30 |
| 1396378741 | April Corellia Bradshaw | Nurse Practitioner | 1301 Ks Highway 264, 1301 Ks Highway 264, Larned, KS 67550 | 2020-02-13 |
| 1770115115 | Corinne Janel Wray | Student in an Organized Health Care Education/Training Program | 512 W 1st St, Larned, KS 67550 | 2020-02-04 |
| 1053892059 | Andy Roger Eugene | Psychiatry & Neurology | 1301 Ks Highway 264, Larned, KS 67550 | 2018-08-27 |
| 1467413443 | Trent D Smith | Dentist | 706 Ft Larned Ave, Box 36, Larned, KS 67550 | 2006-03-30 |
| 1376577288 | Marcel Lacoste | Family Medicine | Box 89, Rural Route 3, Larned, KS 67550-0089 | 2006-07-10 |
| Find all providers in zip 67550 | ||||
| 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 |
|---|---|---|---|---|
| 1861542821 | Reed Discount Pharmacy, Inc | Pharmacy | 326 W 14th St, Larned, KS 67550-2106 | 2007-01-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841807120 | Optumrx, Inc. | Pharmacy | 6800 W 115th Street, Suite 600, Overland Park, KS 66211-9838 | 2020-09-30 |
| 1174132161 | Ascension Via Christi Hospitals Wichita Inc. | Pharmacy | 3600 E Harry St Rm 2001, Wichita, KS 67218-3713 | 2020-07-27 |
| 1932724481 | Mt Oread Pharmacy LLC | Pharmacy | 6265 Rock Chalk Drive, Lmh Health West, Suite 1401, Lawrence, KS 66049 | 2020-06-10 |
| 1174143309 | Central Care, Pa | Pharmacy | 8919 Parallel Pkwy Ste 250, Kansas City, KS 66112-1655 | 2020-04-17 |
| 1942829916 | Sharon Lee Family Health Care, Inc | Pharmacy | 2002 S 51st St, Kansas City, KS 66106-2419 | 2020-04-10 |
| 1629617188 | Leekers Valley Center Inc | Pharmacy | 225 S Meridian, Valley Center, KS 67147 | 2020-01-02 |
| 1811536683 | Active Lifestyle Pharmacy LLC | Pharmacy | 7800 Foster St, Overland Park, KS 66204-2955 | 2019-12-27 |
| 1427694611 | Free State Pharmacy LLC | Pharmacy | 3200 Haskell Ave Ste 140, Lawrence, KS 66046-8945 | 2019-11-21 |
| 1588224315 | Gail Reif Inc. | Pharmacy | 2040 Hutton Rd Ste 101, Kansas City, KS 66109-4566 | 2019-06-14 |
| 1356807044 | Dandurand Wellness, Inc. | Pharmacy | 550 N Hillside St Ste 3-100, Wichita, KS 67214-4910 | 2019-02-18 |
| 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.