SHOPKO STORES OPERATING CO LLC (NPI# 1740236199) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740236199 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 090 |
| Practice Address |
1771 Wisconsin Ave Grafton WI 53024-2437 |
| Practice Telephone | 2623750016 |
| Practice Fax Number | 2623753519 |
| Mailing Telephone | 2623750016 |
| Mailing Fax Number | 2623753519 |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2014-06-06 |
| 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 | 333600000X | Pharmacy | Suppliers | ||
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| N | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
8605042 | WI | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCPDP NUMBER | 5119450 | 01 | |
| WI | 33162200 | 05 |
| Other Name | Type Code |
|---|---|
| ShopKo Pharmacy 090 | 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 |
1771 WISCONSIN AVE |
| City | GRAFTON |
| State | WI |
| Zip Code | 53024-2437 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104879808 | Shopko Stores Operating Co. LLC | Eyewear Supplier (Equipment, not the service) | 1771 Wisconsin Ave, Grafton, WI 53024-2437 | 2006-05-17 |
| 1558845081 | Matthew Francis Byers | Optometrist | 1771 Wisconsin Ave, Grafton, WI 53024-2437 | 2018-09-20 |
| 1770911646 | Jennifer Ford | Pharmacist | 1771 Wisconsin Ave, Grafton, WI 53024-2437 | 2013-10-31 |
| 1740613868 | Robert Edmund Mucha | Pharmacist | 1771 Wisconsin Ave, Grafton, WI 53024-2437 | 2013-08-12 |
| 1548504483 | William F. Petzke | Pharmacist | 1771 Wisconsin Ave, Grafton, WI 53024-2437 | 2012-11-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245739135 | Kathy Anne Herzog | Counselor | 101 Falls Rd Suite 210, Grafton, WI 53024 | 2018-02-06 |
| 1992215867 | Caroline Marie Brandt | Nurse Practitioner | 975 Port Washington Rd Ste 310, Grafton, WI 53024 | 2017-10-05 |
| 1124569181 | Quirt Family Dentistry, Sc | Dentist | 1580 Port Washington Road, Grafton, WI 53024 | 2017-03-10 |
| 1639626260 | Jennifer Pogodzinski | Physical Therapist | 975 N. Port Washington Avenue, Grafton, WI 53024 | 2016-09-01 |
| 1750790119 | Amanda K Olejniczak | Dentist | 1505 Wisconsin Ave, Ste 130, Grafton, WI 53024 | 2014-08-10 |
| 1992053680 | Liliya Lakshtanov | Registered Nurse | 910 E. Paradise Dr., West Bend, WI 53024 | 2012-08-28 |
| 1467708446 | Trevor Holwell | Pharmacist | 1600 N Port Washington Rd, Grafton, WI 53024 | 2012-07-27 |
| 1770838120 | Brian A. Vetterkind | Physical Therapist | 2225 Wisconsin Ave Ste 100, Grafton, WI 53024 | 2012-07-20 |
| 1366774689 | Tracy Lynn Doro-krueger | Counselor | 1814 Arapaho Court, Grafton, WI 53024 | 2010-02-11 |
| 1659507754 | Karen Marie Geschke | Physical Therapist | 2020 Cheyenne Ct., Grafton, WI 53024 | 2009-06-03 |
| Find all providers in zip 53024 | ||||
| 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 |
|---|---|---|---|---|
| 1629219266 | Roundys Supermarkets Inc | Pharmacy | 301 Falls Rd, Grafton, WI 53024-2620 | 2009-03-11 |
| 1356397467 | Lucille R. Vernadakis | Pharmacy | 35053 Royalton Rd, Grafton, OH 44044-9539 | 2006-05-26 |
| 1245284272 | Walgreen Co | Pharmacy | 1915 Wisconsin Ave, Grafton, WI 53024-2605 | 2006-05-22 |
| 1881257889 | Preston Taylor Community Health Centers, Incorporated | Pharmacy | 725 N Pike St, Grafton, WV 26354-1270 | 2019-04-16 |
| 1851581854 | Costco Wholesale Corporation | Pharmacy | 950 Port Washington Rd, Grafton, WI 53024 | 2007-07-26 |
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| 1962053421 | Hayat Pharmacy 19 LLC | Pharmacy | 805 W. Layton Ave. Suite A, Milwaukee, WI 53221 | 2019-09-26 |
| 1275182925 | Walgreen Co | Pharmacy | 2265 N Mayfair Rd, Wauwatosa, WI 53226-2207 | 2019-09-05 |
| 1982257200 | Hayat Pharmacy 16 LLC | Pharmacy | 603 N 36th St, Milwaukee, WI 53208-3826 | 2019-07-17 |
| 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.