SHOPKO STORES OPERATING CO LLC (NPI# 1790095099) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790095099 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 607 |
| Practice Address |
1010 S Mainline Dr Seymour WI 54165-1150 |
| Practice Telephone | 9208330430 |
| Practice Fax Number | 9208337556 |
| Mailing Telephone | 9208830430 |
| Mailing Fax Number | 9208837556 |
| Enumeration Date | 2010-10-20 |
| Last Update Date | 2011-12-09 |
| Authorized Official Name | MR. MICHAEL BETTIGA (EXECUTIVE VICE PRESIDENT AND COO) |
| 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 | 333600000X | Pharmacy | Suppliers | ||
| N | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 1790095099 | 05 |
| Other Name | Type Code |
|---|---|
| ShopKo Pharmacy 607 | 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 |
1010 S MAINLINE DR |
| City | SEYMOUR |
| State | WI |
| Zip Code | 54165-1150 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760816359 | Tim Schellinger | Pharmacist | 1010 S Mainline Dr, Seymour, WI 54165-1150 | 2013-08-30 |
| 1093069650 | John Caldwell | Pharmacist | 1010 S Mainline Dr, Seymour, WI 54165-1150 | 2012-11-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851779789 | Kalli Vandenheuvel | Specialist/Technologist | W3068 Kortney Lane, Seymour, WI 54165 | 2015-05-12 |
| 1316110562 | Christine Sue Peterson | Occupational Therapy Assistant | W 1587 County Highway Ee, Seymour, WI 54165 | 2008-04-09 |
| 1073618849 | General Dentistry of Seymour Inc | Dentist | 344 State Hwy 54, Ste 1, Seymour, WI 54165 | 2006-09-14 |
| 1235234063 | Donald Joseph Hoff Jr. | Dentist | 344 State Highway 54, Ste 1, Seymour, WI 54165 | 2006-09-14 |
| 1871517565 | Mary Therese Leveille | Registered Nurse | 1100 Orchard St, Seymour, WI 54165 | 2006-07-26 |
| 1114995164 | Good Shepherd Home, Ltd | Physical Therapist | 958 Foote Street, Seymour, WI 54165 | 2006-03-08 |
| 1023125416 | Barbara A Pesola | Nurse Practitioner | 1100 Orchard Dr, Seymour, WI 54165 | 2006-08-23 |
| 1235106725 | Good Shepherd Home, Ltd | Assisted Living Facility | 607 E Bronson Rd, Seymour, WI 54165-1040 | 2006-03-02 |
| 1043855190 | Alissa A Huff | Spec/Tech, Pathology | 607 E Bronson Rd, Seymour, WI 54165-1040 | 2019-11-13 |
| 1508298084 | Brooke Tank | Occupational Therapy Assistant | 607 E Bronson Rd, Seymour, WI 54165-1040 | 2013-08-06 |
| Find all providers in zip 54165 | ||||
| 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 |
|---|---|---|---|---|
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| 1366623605 | Walgreen Co | Pharmacy | 319 E Tipton St, Seymour, IN 47274-3513 | 2007-11-15 |
| 1265447866 | United Supermarkets LLC | Pharmacy | 101 N Washington St, Seymour, TX 76380-2556 | 2006-07-30 |
| 1255734992 | Schneck Medical Center | Pharmacy | 411 W Tipton St, Seymour, IN 47274-2363 | 2014-10-08 |
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| 1295377703 | Hayat Pharmacy 21 LLC. | Pharmacy | 2333 Northwestern Ave Ste 120, Racine, WI 53404-2520 | 2019-10-16 |
| 1487296737 | Xperience Pharmacy LLC | Pharmacy | 5715 W Appleton Ave, Milwaukee, WI 53210-2250 | 2019-10-08 |
| 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.