SHOPKO STORES OPERATING CO LLC (NPI# 1912933961) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912933961 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 140 |
| Practice Address |
1964 W Morton Ave Jacksonville IL 62650-2621 |
| Practice Telephone | 2172456259 |
| Practice Fax Number | 2172439251 |
| Mailing Telephone | 2172456259 |
| Mailing Fax Number | 2172439251 |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2014-05-22 |
| Authorized Official Name | MR. MICHAEL J 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 | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| N | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
054015893 | IL | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCPDP NUMBER | 1468722 | 01 | |
| IL | 371110040140 | 05 |
| Other Name | Type Code |
|---|---|
| ShopKo Pharmacy 140 | 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 |
1964 W MORTON AVE |
| City | JACKSONVILLE |
| State | IL |
| Zip Code | 62650-2621 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376593038 | Lori Ann Feezor-ribble | Optometrist | 1964 W Morton Ave, Jacksonville, IL 62650-2621 | 2006-05-11 |
| 1346490240 | Kristi A. Diblasi | Pharmacist | 1964 W Morton Ave, Jacksonville, IL 62650-2621 | 2008-09-26 |
| 1679525729 | Shopko Stores Operating Co. LLC | Eyewear Supplier (Equipment, not the service) | 1964 W Morton Ave, Jacksonville, IL 62650-2621 | 2006-05-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134768708 | Stephanie Lee Mabus | Occupational Therapy Assistant | 873 Gorve St, Jacksonville, IL 62650 | 2019-12-31 |
| 1285281071 | Sharshon Pharmacy Inc | Pharmacy | 154 W Morton Ave, Jacksonville, IL 62650 | 2019-08-26 |
| 1992275499 | Brittany Ruth Helmich | Counselor | 340 W. State St., Jacksonville, IL 62650 | 2018-11-28 |
| 1811391782 | Rodney E. Overstreet | Hearing Instrument Specialist | 1521 W. Walnut, Jacksonville, IL 62650 | 2014-10-21 |
| 1407979818 | Jan Ala | Speech-Language Pathologist | 1111 W Morton, Speechworks, Jacksonville, IL 62650 | 2007-04-09 |
| 1083787592 | Eldon G Barrowes Dds & Assoc PC | Dentist | 1515 West Walnut, Bldg #3, Jacksonville, IL 62650 | 2006-11-15 |
| 1194895979 | Joseph J Kozma | Internal Medicine | 1440 West Walnut, Jacksonville, IL 62650 | 2006-11-08 |
| 1740350529 | Susan Weller | Dentist | 1614 West Lafayette Avenue, Jackson, IL 62650 | 2006-11-08 |
| 1659467793 | Shawn M Fry | Family Medicine | 610 N. Westgate, Jacksonville, IL 62650 | 2006-10-05 |
| 1518050061 | Ward Richard Dunseth II | Nurse Anesthetist, Certified Registered | 1400 W Walnut, Jacksonville, IL 62650 | 2006-10-02 |
| Find all providers in zip 62650 | ||||
| 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 |
|---|---|---|---|---|
| 1285281071 | Sharshon Pharmacy Inc | Pharmacy | 154 W Morton Ave, Jacksonville, IL 62650 | 2019-08-26 |
| 1275191983 | University Pharmacy of Jacksonville, Inc | Pharmacy | 3901 University Blvd S Ste 237, Jacksonville, FL 32216-4390 | 2019-05-29 |
| 1992273023 | Public Square Pharmacy LLC | Pharmacy | 11757 Beach Blvd Ste 7, Jacksonville, FL 32246-6633 | 2018-11-07 |
| 1841707940 | Excel Pharmacy Partners LLC | Pharmacy | 6817 Southpoint Pkwy Ste 2204, Jacksonville, FL 32216-8200 | 2018-01-10 |
| 1144735556 | Costco Wholesale Corporation | Pharmacy | 8000 Parramore Rd, Jacksonville, FL 32244 | 2017-12-07 |
| 1912418286 | Av 1 Pharma LLC | Pharmacy | 1539 University Blvd N, Jacksonville, FL 32211-5229 | 2017-10-13 |
| 1629589908 | A V 2 Pharma LLC | Pharmacy | 1537 University Blvd N # Dn, Jacksonville, FL 32211-5229 | 2017-10-13 |
| 1881117109 | Summit Vision Inc. | Pharmacy | 3416 Moncrief Rd Ste 101, Jacksonville, FL 32209-4340 | 2017-07-18 |
| 1316486525 | Smart Pharmacy Inc | Pharmacy | 14003 Beach Blvd # 1, Jacksonville, FL 32250-1541 | 2017-02-21 |
| 1033565585 | New Lynk, LLC | Pharmacy | 5800 Beach Blvd Ste 105, Jacksonville, FL 32207-5180 | 2016-05-13 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 62650 |
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.