SHOPKO STORES OPERATING CO LLC (NPI# 1750333134) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750333134 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 670 |
| Practice Address |
615 Dearborn St Wayne NE 68787-2244 |
| Practice Telephone | 4023752079 |
| Practice Fax Number | 4023752082 |
| Mailing Telephone | 4023752079 |
| Mailing Fax Number | 4023752082 |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2012-09-12 |
| 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 | 333600000X | Pharmacy | Suppliers | ||
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NE | 10025416100 | 05 | |
| IA | 0721878 | 05 | |
| NE | 10024985800 | 05 | |
| NCPDP | 2816582 | 01 | |
| IA | 0565648 | 05 |
| Other Name | Type Code |
|---|---|
| Shopko Pharmacy 670 | 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 |
615 DEARBORN ST |
| City | WAYNE |
| State | NE |
| Zip Code | 68787-2244 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396209623 | Pearl Street Counseling, LLC | Counselor | 421 N Pearl Street, Wayne, NE 68787 | 2019-01-31 |
| 1760883367 | Northeast Nebraska Public Health Department | Public Health or Welfare | 215 Pearl Street, Wayne, NE 68787 | 2014-09-15 |
| 1942419353 | Muffin Elaine Morris | Specialist/Technologist | 11 11 Main Street, Wayne State College, Wayne, NE 68787 | 2007-05-22 |
| 1801952601 | Craig W Braun | Dentist | 206 E 7th St, Wayne, NE 68787 | 2006-12-28 |
| 1124120464 | Robert Kevin Krugman | Chiropractor | 214 Pearl Street, Wayne, NE 68787 | 2006-09-05 |
| 1659722908 | Michele Albers | Physical Therapist | 1200 Providence Road, Wayne, NE 68787 | 2016-06-28 |
| 1730599762 | Angela Mclaughlin | Family Medicine | 615 E 14th St, Wayne, NE 68787 | 2014-04-29 |
| 1083977474 | Amy Joan Bowers | Physical Therapist | 1200 Providence Rd, Wayne, NE 68787 | 2012-06-20 |
| 1205195831 | Michelle Theis | Occupational Therapist | 1200 Providence Rd, Wayne, NE 68787 | 2012-05-16 |
| 1649568775 | Grace Counseling Services | Community/Behavioral Health | 111 Main Street, Wayne, NE 68787 | 2011-07-11 |
| Find all providers in zip 68787 | ||||
| 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 |
|---|---|---|---|---|
| 1457819922 | Providence Medical Center | Pharmacy | 803 Providence Rd Ste 101, Wayne, NE 68787-1590 | 2019-03-04 |
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| 1679948178 | Valurx | Pharmacy | 2075 Hamburg Tpk, Wayne, NJ 07470 | 2015-12-09 |
| 1093104481 | In Him Pharmaceutical Services Inc | Pharmacy | 35400 E Michigan Ave, Wayne, MI 48184-1699 | 2015-01-22 |
| 1144308768 | Fairfield Pharmacy Inc | Pharmacy | 701 Hendricks St., Wayne, WV 25570 | 2006-11-01 |
| 1043319395 | Thrift Drug Inc | Pharmacy | 315 E Lancaster Ave, Wayne, PA 19087-4201 | 2006-09-22 |
| 1962506709 | Pennsylvania Cvs Pharmacy, L.L.C. | Pharmacy | 316 E Lancaster Ave, Wayne, PA 19087-4301 | 2006-09-12 |
| 1063514354 | Woodward Detroit Cvs, L.L.C. | Pharmacy | 31450 Van Born Rd, Wayne, MI 48184-2631 | 2006-09-05 |
| 1801904271 | Cobb Pharmacy | Pharmacy | 4603 S Wayne Rd, Wayne, MI 48184-2310 | 2006-08-27 |
| 1578678355 | Inserra Supermarket Incorporated | Pharmacy | 641 Hamburg Tpke, Wayne, NJ 07470-2098 | 2006-08-20 |
| Find all providers in WAYNE | ||||
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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.