SHOPKO STORES OPERATING CO LLC (NPI# 1760665160) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760665160 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 504 |
| Practice Address |
W3208 Van Roy Rd Appleton WI 54915 |
| Practice Telephone | 9201111111 |
| Enumeration Date | 2007-12-10 |
| Last Update Date | 2008-08-15 |
| Authorized Official Name | MICHAEL 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 | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 36227000 | 05 |
| Other Name | Type Code |
|---|---|
| ShopKo Pharmacy 504 | 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 |
W3208 VAN ROY RD |
| City | APPLETON |
| State | WI |
| Zip Code | 54915 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437341385 | Christine Annette Klawiter | Emergency Medicine | W3208 Van Roy Rd, Appleton, WI 54915-4086 | 2007-08-14 |
| 1972035061 | Samantha A Eiting | Nurse Practitioner | W3208 Van Roy Rd, Appleton, WI 54915-4086 | 2017-03-29 |
| 1932532751 | Nathan Paul Cichocki | Pharmacist | W3208 Van Roy Rd, Appleton, WI 54915-4086 | 2013-08-15 |
| 1407297369 | Sarah Kane | Pharmacist | W3208 Van Roy Rd, Appleton, WI 54915-4086 | 2013-07-08 |
| 1114100518 | Shopko Stores Operating Co LLC | Eyewear Supplier (Equipment, not the service) | W3208 Van Roy Rd, Appleton, WI 54915 | 2007-12-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205466737 | Leyes Robers Dental LLC | Dentist | 3216 W County Rd Kk, Appleton, WI 54915 | 2020-01-23 |
| 1912426958 | Shanna L. Larsen | Registered Nurse | 1101 E. South River St., Appleton, WI 54915 | 2017-09-11 |
| 1477082816 | Amy Fazel | Driver | 226 E Calumet St, Appleton, WI 54915 | 2017-06-08 |
| 1871940213 | B.a.israel LLC | Community Based Residential Treatment Facility, Mental Illness | N9520 Silver Court, Appleton, WI 54915 | 2016-05-16 |
| 1982933479 | Stephanie I. Braski | Counselor | 1531 S. Oneida St, Appleton, WI 54915 | 2009-12-14 |
| 1386808319 | Shawn S Williamson | Emergency Medicine | 1506 South Oneida Street, Appleton, WI 54915 | 2008-07-18 |
| 1700040870 | Heidi Jo Van Toll | Occupational Therapist | 1335 S Oneida Street, Appleton, WI 54915 | 2008-07-17 |
| 1669639142 | Ascension Medical Group-fox Valley Wisconsin, Inc | Clinic/Center | N9642 County Rd N, Appleton, WI 54915 | 2008-05-21 |
| 1265699748 | Ascension Medical Group-fox Valley Wisconsin, Inc | Clinic/Center | 1531 S Madison St Fl 4, Appleton, WI 54915 | 2008-05-21 |
| 1073770558 | Ascension Medical Group-fox Valley Wisconsin, Inc | Clinic/Center | 1531 S Madison St Ste 580, Appleton, WI 54915 | 2008-05-21 |
| Find all providers in zip 54915 | ||||
| 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 |
|---|---|---|---|---|
| 1427514504 | Northland Hometown Pharmacy LLC | Pharmacy | 420 E Northland Ave Ste H, Appleton, WI 54911-2159 | 2019-02-14 |
| 1528395522 | Roundys Supermarkets Inc | Pharmacy | 511 W Calumet St, Appleton, WI 54915-1462 | 2009-11-11 |
| 1053645986 | Morton Drug Co Inc | Pharmacy | 2500 E Capitol Dr Ste 1500, Appleton, WI 54911-8735 | 2009-09-24 |
| 1851529101 | Walgreen Co | Pharmacy | 2803 N Meade St, Appleton, WI 54911-1507 | 2009-06-25 |
| 1487895108 | Roundys Supermarkets Inc | Pharmacy | 2700 N Ballard Rd, Appleton, WI 54911-8657 | 2009-03-09 |
| 1487661302 | Walgreen Co | Pharmacy | 1901 S Oneida St, Appleton, WI 54915-1834 | 2006-08-02 |
| 1376565077 | Wisconsin Cvs Pharmacy LLC | Pharmacy | 1800 S Kensington Dr, Appleton, WI 54915-4136 | 2006-07-24 |
| 1851325070 | Aurora Pharmacy Inc | Pharmacy | 1919 E Calumet St, Appleton, WI 54915-4741 | 2006-07-11 |
| 1679507891 | Aurora Pharmacy Inc | Pharmacy | 2400 W Wisconsin Ave, Appleton, WI 54914-3109 | 2006-07-11 |
| 1619918588 | Wisconsin Cvs Pharmacy LLC | Pharmacy | 700 W Wisconsin Ave, Appleton, WI 54914-3567 | 2006-06-09 |
| Find all providers in APPLETON | ||||
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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.