SHOPKO STORES OPERATING CO LLC (NPI# 1962442392) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962442392 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 113 |
| Practice Address |
5500 Martin Way E Lacey WA 98516-6326 |
| Practice Telephone | 3604564057 |
| Practice Fax Number | 3604560903 |
| Mailing Telephone | 3604564057 |
| Mailing Fax Number | 3604560903 |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2008-08-14 |
| 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 | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
CF00058640 | WA | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCPDP NUMBER | 4923175 | 01 | |
| WA | 0006013270 | 05 | |
| WA LABOR & INDUSTRY | 0047611 | 01 | |
| WA LABOR & INDUSTRY | 0215810 | 01 |
| Other Name | Type Code |
|---|---|
| ShopKo Pharmacy 113 | 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 |
5500 MARTIN WAY E |
| City | LACEY |
| State | WA |
| Zip Code | 98516-6326 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033161419 | Shopko Stores Operating Co. LLC | Optometrist | 5500 Martin Way E, Lacey, WA 98516-6326 | 2006-05-16 |
| 1972879401 | Kenneth R Petersen | Pharmacist | 5500 Martin Way E, Lacey, WA 98516-6326 | 2012-03-29 |
| 1720351000 | Michelle Teri Kautzmann | Pharmacist | 5500 Martin Way E, Lacey, WA 98516-6326 | 2012-02-16 |
| 1336336742 | George Christian Wang | Pharmacist | 5500 Martin Way E, Lacey, WA 98516-6326 | 2007-09-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730744210 | Michael Oropeza | Behavioral Analyst | 8282 28th Court Northeast, Suite A, Lacey, WA 98516 | 2019-05-09 |
| 1902361330 | Amanda Jessica Mae Allen | Behavioral Analyst | Basics Nw LLC, 8282 28th Ct Ne Suite A, Lacey, WA 98516 | 2019-02-11 |
| 1619459393 | Kayla-renee Williams | Behavioral Analyst | Basics Nw LLC 8282 28th Ct Ne, Suite A, Lacey, WA 98516 | 2018-08-30 |
| 1174004303 | Julie Ann Lisowski | Massage Therapist | 3532 Cuddy Ln Ne, Lacey, WA 98516 | 2018-08-26 |
| 1740700145 | Joseph Brandon Kimmel | Denturist | 5032 Beverly Dr Ne, Olympia, WA 98516 | 2017-06-27 |
| 1649649880 | Katie Cole | Behavioral Analyst | 8282 28th Ct Ne, Suite A, Basics Nw, LLC, Lacey, WA 98516 | 2015-09-17 |
| 1306234166 | Reza Tahernia | Dentist | 8050 Freedon Lane Ne, Suite C, Lacey, WA 98516 | 2015-01-02 |
| 1770997603 | Qualified Surgical Services Pllc | Surgery | 3697 Cameron Dr Ne, Lacey, WA 98516 | 2014-06-18 |
| 1184048688 | Stephanie Renee Hjortedal | Specialist/Technologist | 8750 Tallon Lane Ne., Lacey, WA 98516 | 2014-02-05 |
| 1295169811 | Teasha Corrado | Behavioral Analyst | 8282 28th Court Ne, Suite A, Lacey, WA 98516 | 2013-08-30 |
| Find all providers in zip 98516 | ||||
| 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 |
|---|---|---|---|---|
| 1700996352 | Costco Wholesale Corporation | Pharmacy | 1470 Marvin Rd Ne, Lacey, WA 98516 | 2006-08-30 |
| 1235162579 | Haggen Inc | Pharmacy | 5600 Martin Way E, Lacey, WA 98516-6308 | 2006-07-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700493533 | Doctors Pharmacy, LLC | Pharmacy | 65 Columbia Point Dr, Richland, WA 99352-4375 | 2020-09-25 |
| 1871105999 | Whidbey Island Public Hospital District | Pharmacy | 7 Ne Birch St, Coupeville, WA 98239-3132 | 2020-08-19 |
| 1710504550 | Kayshuv Enterprises | Pharmacy | 7505 Sandifur Pkwy, Suite 102, Pasco, WA 99301 | 2020-06-27 |
| 1811511454 | Kaiser Foundation Health Plan of Washington | Pharmacy | 189 Telegraph Rd, Bellingham, WA 98226-8079 | 2020-05-29 |
| 1548883630 | Capsule Seattle LLC | Pharmacy | 2033 6th Ave Ste 120, Seattle, WA 98121-2526 | 2020-05-22 |
| 1063048197 | Peninsula Pharmacies Inc Long Beach Pharmacy Annex | Pharmacy | 110 Oregon Ave S, Long Beach, WA 98631 | 2020-03-20 |
| 1174155345 | Kaiser Foundation Health Plan of Washington | Pharmacy | 2335 172nd Street Ne, Marysville, WA 98271 | 2020-02-06 |
| 1245861996 | Salish Integrative Medicine, Inc | Pharmacy | 3700 Pacific Hwy E Ste 100b, Fife, WA 98424-1160 | 2020-01-31 |
| 1700417854 | Prosser Southgate Pharmacy Inc | Pharmacy | 207 Canyon Drive, Prosser, WA 99350-1009 | 2020-01-28 |
| 1700423639 | Venkateswara LLC | Pharmacy | 515 Minor Ave Ste 120, Seattle, WA 98104-2138 | 2019-12-10 |
| Find all providers with the same taxonomy | ||||
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.