SHOPKO STORES OPERATING CO LLC (NPI# 1639121155) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639121155 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 111 |
| Practice Address |
1230 Lancaster Dr Se Salem OR 97317-5800 |
| Practice Telephone | 5033716830 |
| Practice Fax Number | 5033718159 |
| Mailing Telephone | 5033716830 |
| Mailing Fax Number | 5033718159 |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2016-04-06 |
| Authorized Official Name | MR. RUSSELL STEINHORST (SVP CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 9204297489 |
| 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 |
1193 | OR | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 038658 | 05 | |
| OR | 278380 | 05 | |
| OR | 278347 | 05 | |
| NCPDP NUMBER | 3810721 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Pharmacy 111 | 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 |
1230 LANCASTER DR SE |
| City | SALEM |
| State | OR |
| Zip Code | 97317-5800 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790736023 | Shopko Stores Operating Co LLC | Eyewear Supplier (Equipment, not the service) | 1230 Lancaster Dr Se, Salem, OR 97317-5800 | 2006-05-12 |
| 1669950325 | Julie Trinh Le | Pharmacist | 1230 Lancaster Dr Se, Salem, OR 97317-5800 | 2018-08-03 |
| 1679029326 | Adam Nguyen | Pharmacist | 1230 Lancaster Dr Se, Salem, OR 97317-5800 | 2016-08-31 |
| 1306110143 | Leslie Aaron Eddleman | Pharmacist | 1230 Lancaster Dr Se, Salem, OR 97317-5800 | 2012-02-24 |
| 1689947046 | Sylvia Kay Fisher | Pharmacist | 1230 Lancaster Dr Se, Salem, OR 97317-5800 | 2012-02-15 |
| 1629341037 | Jerry Gary Sachtjen | Pharmacist | 1230 Lancaster Dr Se, Salem, OR 97317-5800 | 2012-02-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962932996 | Corinna Leona Zib | Counselor | 4726 Appaloosa Ct Se, Salem, OR 97317 | 2017-06-13 |
| 1639537889 | Nikole Stormo | Massage Therapist | 4675 Campbell Dr Se Apt267, Salem, OR 97317 | 2016-02-03 |
| 1174698971 | Christian Community Placement Center | Foster Care Agency | 4890 32nd Ave Se, Salem, OR 97317 | 2006-11-21 |
| 1235653569 | Alexis Panther | Community Health Worker | 4890 32nd Ave Se, Salem, OR 97317 | 2017-07-28 |
| 1114479128 | Jocelyn Gran | Pharmacist | 2400 Lancaster Dr Ne, Salem, OR 97317 | 2016-10-26 |
| 1841410057 | Jennifer Krug | Specialist/Technologist | 5000 Deer Park Dr Se, Salem, OR 97317 | 2007-04-27 |
| 1649498262 | Carol Adams | Social Worker | 1164 63rd Ave Ne, Salem, OR 97317-2313 | 2007-04-20 |
| 1992114490 | Pathways - Child and Family Services - LLC | Community/Behavioral Health | 1164 63rd Ave Ne, Salem, OR 97317-2313 | 2014-08-08 |
| 1417513235 | James Matthew Conway | Social Worker | 5100 Center St Ne, Salem, OR 97317-3217 | 2019-05-16 |
| 1043876865 | Home Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 5100 Center St Ne, Salem, OR 97317-3217 | 2019-05-16 |
| Find all providers in zip 97317 | ||||
| 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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| 1316047749 | Cvs Pharmacy Inc | Pharmacy | 272 Highland Ave, Salem, MA 01970-1832 | 2006-09-25 |
| 1366542318 | Guffeys Pharmacy Inc | Pharmacy | 172 Hwy 62 E, Suite 2, Salem, AR 72576-0155 | 2006-09-22 |
| 1487753836 | Cvs Pharmacy Inc | Pharmacy | 200 Essex St, Salem, MA 01970-3705 | 2006-09-22 |
| 1730288184 | Cvs Pharmacy Inc | Pharmacy | 426b Essex St, Salem, MA 01970-3152 | 2006-09-22 |
| 1982707618 | Virginia Cvs Pharmacy, L.L.C. | Pharmacy | 179 Electric Rd, Salem, VA 24153-4432 | 2006-09-07 |
| Find all providers in SALEM | ||||
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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.