SHOPKO STORES OPERATING CO LLC (NPI# 1912933813) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912933813 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 145 |
| Practice Address |
1190 N 6th St Monmouth IL 61462-9672 |
| Practice Telephone | 3097347579 |
| Practice Fax Number | 3097348111 |
| Mailing Telephone | 3097347579 |
| Mailing Fax Number | 3097348111 |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2016-12-23 |
| Authorized Official Name | MR. RUSSELL STEINHORST (SVP CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 9204297489 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| N | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
054015892 | IL | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCPDP NUMBER | 1468695 | 01 | |
| IL | 371110040145 | 05 |
| Other Name | Type Code |
|---|---|
| ShopKo Pharmacy 145 | 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 |
1190 N 6TH ST |
| City | MONMOUTH |
| State | IL |
| Zip Code | 61462-9672 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295788842 | Shopko Stores Operating Co. LLC | Eyewear Supplier (Equipment, not the service) | 1190 N 6th St, Monmouth, IL 61462-9672 | 2006-05-17 |
| 1619048436 | Steven Shearer | Pharmacist | 1190 N 6th St, Monmouth, IL 61462-9672 | 2006-11-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740806942 | Michelle N Smith | Registered Nurse | 1220 E. 2nd Avenue, Monmouth, IL 61462 | 2020-06-23 |
| 1518413103 | Daniel Chard | Emergency Medical Technician, Basic | 331 S. 6th St, Monmouth, IL 61462 | 2016-09-01 |
| 1174079388 | Patrick Spears | Emergency Medical Technician, Paramedic | 601 Industrial Park Road, Monmouth, IL 61462 | 2016-08-28 |
| 1326222993 | Terri Lynn Gittings | Registered Nurse | Industrial Park Road, Bridgeway Inc, Monmouth, IL 61462 | 2007-12-19 |
| 1811011422 | Hancock Mcdonough Roe 21 | Local Education Agency (LEA) | 1301 N Main, Ste 3, Monmouth, IL 61462 | 2007-03-19 |
| 1295870137 | Warren Achievement Center Inc | Case Management | 1220 East Second Avenue, Monmouth, IL 61462 | 2007-02-20 |
| 1265432363 | Community Medical Center of Western Il Inc | Home Health | 1000 W Harlem Ave, Monmouth, IL 61462-1007 | 2005-07-29 |
| 1285253997 | Catherine Jane Steck | Physical Therapist | 1000 W Harlem Ave, Monmouth, IL 61462-1007 | 2020-04-13 |
| 1205482254 | Tonya Renee Gibbs | Nurse Practitioner | 1000 W Harlem Ave, Monmouth, IL 61462-1007 | 2019-08-15 |
| 1285193441 | Carrie Anne Green | Nurse Practitioner | 1000 W Harlem Ave, Monmouth, IL 61462-1007 | 2019-03-18 |
| Find all providers in zip 61462 | ||||
| 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 |
|---|---|---|---|---|
| 1467684407 | Dc3 Pharmacy Partners Inc | Pharmacy | 1120 N 6th St, Monmouth, IL 61462-9672 | 2009-08-09 |
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| 1982212635 | Grand Pharmacy LLC | Pharmacy | 229 W Grand Ave Ste F, Bensenville, IL 60106-3365 | 2020-07-20 |
| 1871110254 | Illini Clinic Pharmacy Inc | Pharmacy | 103 N Prospect St, Cambridge, IL 61238-1148 | 2020-07-01 |
| 1831716745 | The Project of The Quad Cities | Pharmacy | 1701 River Dr Ste 106, Moline, IL 61265-1384 | 2020-06-26 |
| 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.