SHOPKO STORES OPERATING CO LLC (NPI# 1649223249) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649223249 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 2621 |
| Practice Address |
717 E Lakeshore Dr Manistique MI 49854-1682 |
| Practice Telephone | 9063413994 |
| Practice Fax Number | 9063413996 |
| Mailing Telephone | 9063413994 |
| Mailing Fax Number | 9063413996 |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2015-12-15 |
| Authorized Official Name | MR. RUSSELL STEINHORST (SVP AND COO) |
| 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 | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MEDICARE ID - TYPE UNSPECIFIED | 0459230120 | 01 |
| Other Name | Type Code |
|---|---|
| Shopko Pharmacy 2621 | 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 |
717 E LAKESHORE DR |
| City | MANISTIQUE |
| State | MI |
| Zip Code | 49854-1682 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407980469 | Amanda Pletcher | Pharmacist | 717 E Lakeshore Dr, Manistique, MI 49854-1682 | 2007-03-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134752215 | Sarah Jo Miller | Massage Therapist | 610 E Lakeshore Dr, Manistique, MI 49854 | 2020-02-18 |
| 1669961611 | Carole Lynn Hare | Counselor | 159 N Maple Stree, Manistique, MI 49854 | 2018-05-05 |
| 1457898165 | Mark A Rohde | Pharmacist | 211 S Cedar Street, Manistique, MI 49854 | 2017-01-20 |
| 1801137229 | Tracey A Marino | Nurse Practitioner | 7870 W. Us 2, Schoolcraft Memorial Hospital, Manistique, MI 49854 | 2013-03-11 |
| 1366786303 | Melissa L Carlson | Counselor | 5698 W. Hwy Us2, Manistique, MI 49854 | 2012-11-15 |
| 1255666939 | Little Ones of The Up, LLC | Community/Behavioral Health | 300 Walnut Rm 155, Manistique, MI 49854 | 2009-10-13 |
| 1629303441 | Great Lakes Recovery Centers, Inc. | Substance Abuse Rehabilitation Facility | 601 Lakeshore Drive, Suite 101, Manistique, MI 49854 | 2009-10-13 |
| 1073756961 | Trisha Ann Mcevers | Social Worker | 601 E. Lakeshore Drive, Suite 102, Manistique, MI 49854 | 2009-04-08 |
| 1043359409 | Nora Lynn Brewster | Social Worker | 8716 N Boot Lake Rd, Manistique, MI 49854 | 2007-02-05 |
| 1588717839 | Sault Tribe of Chippewa Indians | Clinic/Center | 5698w Hwy Us2, Manistique, MI 49854 | 2007-01-19 |
| Find all providers in zip 49854 | ||||
| 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 |
|---|---|---|---|---|
| 1275673428 | Manistique Pharmaceuticals Inc | Pharmacy | 211 S Cedar St, Manistique, MI 49854-1425 | 2007-02-07 |
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| 1881292001 | Healthwatch Pharmacy Inc | Pharmacy | 1375 S Lapeer Rd Ste 102, Lake Orion, MI 48360-1421 | 2020-10-09 |
| 1225645781 | Good Choice Pharmacy LLC | Pharmacy | 6750 E 10 Mile Rd, Center Line, MI 48015-1166 | 2020-09-29 |
| 1487269122 | Canfield Pharmacy LLC | Pharmacy | 4673 Conner St, Detroit, MI 48215-2028 | 2020-09-10 |
| 1851905707 | Skidway Pharmacy LLC | Pharmacy | 1830 Greenwood Rd, Prescott, MI 48756-8627 | 2020-09-08 |
| 1023621190 | Azam Mohsen Mesleh | Pharmacy | 6811 Theisen St, Dearborn, MI 48126-1927 | 2020-08-28 |
| 1821606310 | S&k Pharmacy Inc. | Pharmacy | 1916 Davison Rd, Flint, MI 48506-4423 | 2020-07-21 |
| Find all providers with the same taxonomy | ||||
| City | MANISTIQUE |
| Zip Code | 49854 |
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.