SHOPKO STORES OPERATING CO LLC (NPI# 1811157662) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811157662 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 179 |
| Practice Address |
5630 St Croix Trail North Branch MN 55056 |
| Practice Telephone | 6516749956 |
| Practice Fax Number | 6516749907 |
| Mailing Telephone | 6516749956 |
| Mailing Fax Number | 6516749907 |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2014-07-25 |
| Authorized Official Name | MR. 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 | ||
| N | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCPDP | 2429226 | 01 | |
| MN | 387482100 | 05 |
| Other Name | Type Code |
|---|---|
| ShopKo Pharmacy 179 | 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 |
5630 ST CROIX TRAIL |
| City | NORTH BRANCH |
| State | MN |
| Zip Code | 55056 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689835647 | Shopko Stores Operating Co LLC | Eyewear Supplier (Equipment, not the service) | 5630 St Croix Trail, North Branch, MN 55056 | 2008-06-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306217146 | Joy Solano | Counselor | 38873 14th Ave North, North Branch, MN 55056 | 2015-10-19 |
| 1285072637 | Teresa Ann Dewitt | Registered Nurse | 9208 St Croix Trail, North Branch, MN 55056 | 2013-06-07 |
| 1396074209 | Twin Cities Mobile Chiropractic, P.C. | Clinic/Center | 6754 380th Circle, North Branch, MN 55056 | 2009-12-24 |
| 1023171196 | Shawn Timothy Mccullough | Dentist | 6041 Main Street, Suite C, North Branch, MN 55056 | 2006-12-19 |
| 1518050103 | Paula J Rehder | Family Medicine | 6413 Oak Street, North Branch, MN 55056 | 2006-10-02 |
| 1699711614 | Julie A Perreault | Chiropractor | 6361 Main St, No Branch, MN 55056 | 2006-06-20 |
| 1760950307 | Kara H Mireles | Marriage & Family Therapist | 5842 Old Main St, Ste 2,3,4, North Branch, MN 55056 | 2018-11-12 |
| 1134614506 | Jenna Marie Leirmoe | Counselor | 38878 12th Ave, North Branch, MN 55056 | 2018-06-27 |
| 1194849687 | County Valu Pharmacy | Pharmacy | 6445 Main Street, North Branch, MN 55056 | 2007-03-19 |
| 1811081516 | Thomas A Leaf | Family Medicine | 6413 Oak Street, North Branch, MN 55056 | 2006-10-03 |
| Find all providers in zip 55056 | ||||
| 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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|---|---|---|---|---|
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| 1891806394 | Advanced Pharmacy & Nutrition Center | Pharmacy | 3960 Huron St, North Branch, MI 48461-6122 | 2006-08-31 |
| 1841502705 | Ehardt's Pharmacy Inc. | Pharmacy | 6002 N Lapeer Rd, North Branch, MI 48461-8150 | 2010-07-08 |
| 1982751038 | Ehardts Pharmacy Inc | Pharmacy | 3960 Huron St, North Branch, MI 48461-8149 | 2007-01-04 |
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| 1659938116 | Sterlingrx Inc | Pharmacy | 1312 Northland Dr Ste 500, Mendota Heights, MN 55120-1436 | 2019-05-21 |
| 1639734346 | Seward Pharmacy LLC | Pharmacy | 2209 E Lake St, Minneapolis, MN 55407-4563 | 2019-05-08 |
| 1093370694 | Minnesota Ave N Pharmacy Services Limited | Pharmacy | 226 Minnesota Ave N, Aitkin, MN 56431-1412 | 2019-05-08 |
| 1487117792 | Costco Wholesale Corporation | Pharmacy | 3636 2nd St S, Saint Cloud, MN 56301-3732 | 2019-04-12 |
| Find all providers with the same taxonomy | ||||
| City | NORTH BRANCH |
| Zip Code | 55056 |
Please comment or provide details below to improve the information on SHOPKO STORES OPERATING CO LLC.
| 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.