SHOPKO STORES OPERATING CO LLC (NPI# 1679524037) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679524037 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 047 |
| Practice Address |
100 S 66th St Lincoln NE 68510-2301 |
| Practice Telephone | 4024897148 |
| Practice Fax Number | 4024896240 |
| Mailing Telephone | 4024897148 |
| Mailing Fax Number | 4024896240 |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2014-03-05 |
| 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 |
2681 | NE | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NE | 10025414100 | 05 | |
| NCPDP NUMBER | 2812382 | 01 | |
| NE | 10025070800 | 05 |
| Other Name | Type Code |
|---|---|
| ShopKo Pharmacy 047 | 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 |
100 S 66TH ST |
| City | LINCOLN |
| State | NE |
| Zip Code | 68510-2301 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144273327 | Robert David Sanders | Optometrist | 100 S 66th St, Lincoln, NE 68510-2301 | 2006-05-18 |
| 1467404699 | Shopko Stores Operating Co. LLC | Eyewear Supplier (Equipment, not the service) | 100 S 66th St, Lincoln, NE 68510-2301 | 2006-05-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659925121 | Nichole Renee Boggs | Pharmacist | 7045 O St., Lincoln, NE 68510 | 2019-08-01 |
| 1700361573 | Sue Marie Maxwell | Licensed Practical Nurse | Lincoln Public Schools, 5905 O Street, Lincoln, NE 68510 | 2018-09-27 |
| 1649752759 | Kathryn Jean Kuzelka | Licensed Practical Nurse | 544 South 28th Street, Lincoln, NE 68510 | 2018-09-05 |
| 1013404599 | Amanda Ehlers | Registered Nurse | Lps District Office, 5905 O Street, Lincoln, NE 68510 | 2018-04-19 |
| 1225535081 | Jana Kathleen Mcnemar | Counselor | 245 South 84th Street, Suite 212, Lincoln, NE 68510 | 2018-04-09 |
| 1265932313 | Kimberly Elwood | Specialist/Technologist | 2229 J St., Lincoln, NE 68510 | 2018-02-15 |
| 1881193266 | Susan Kangas-packett | Registered Nurse | 1000 South 70th St., East High School, Health Office, Lincoln, NE 68510 | 2018-02-12 |
| 1023517000 | Tara Johnson | Licensed Practical Nurse | Lpsdo 5905 O St, Lincoln, NE 68510 | 2018-02-06 |
| 1427566413 | Tracy Russell | Counselor | 245 S 84th Street, Suite 212, Lincoln, NE 68510 | 2018-01-12 |
| 1447778964 | Erin Elizabeth Cristello | Speech-Language Pathologist | 300 S 48th Street, Lincoln, NE 68510 | 2017-09-05 |
| Find all providers in zip 68510 | ||||
| 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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| 1891085486 | Alcona Citizens for Health, Inc. | Pharmacy | 177 N Barlow, Lincoln, MI 48742 | 2011-04-15 |
| 1548576192 | Nebraska Cvs Pharmacy LLC | Pharmacy | 4808 O St, Lincoln, NE 68510-1908 | 2010-08-20 |
| 1831230036 | Nebraska Medical Center | Pharmacy | 550 N. 19th Street, Lincoln, NE 68588 | 2007-02-09 |
| 1194898197 | Four Star Drug of Bethany Inc | Pharmacy | 1340 N 66th St, Lincoln, NE 68505-1822 | 2006-11-16 |
| 1528131521 | Four Star Drug of Lincoln Nebraska Inc | Pharmacy | 1265 S Cotner Blvd, Lincoln, NE 68510-4923 | 2006-11-16 |
| Find all providers in LINCOLN | ||||
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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.