SHOPKO STORES OPERATING CO LLC (NPI# 1972557106) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972557106 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 630 |
| Practice Address |
1625 E Blaschko Ave Arcadia WI 54612-1835 |
| Practice Telephone | 6083238134 |
| Practice Fax Number | 6083238434 |
| Mailing Telephone | 6083238134 |
| Mailing Fax Number | 6083238434 |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2012-09-04 |
| Authorized Official Name | MR. MICHAEL BETTIGA (EXECUTIVE VICE PRESIDENT & 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 | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MEDICARE ID - TYPE UNSPECIFIED | 0459230083 | 01 |
| Other Name | Type Code |
|---|---|
| Shopko Pharmacy 630 | 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 |
1625 E BLASCHKO AVE |
| City | ARCADIA |
| State | WI |
| Zip Code | 54612-1835 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235483686 | Natasha Haines | Pharmacy Technician | 1625 E Blaschko Ave, Arcadia, WI 54612-1835 | 2012-11-07 |
| 1891049359 | Amber Rae Semb | Pharmacy Technician | 1625 E Blaschko Ave, Arcadia, WI 54612-1835 | 2012-11-06 |
| 1790039345 | Shopko Pharmacy | Pharmacy | 1625 E Blaschko Ave, Arcadia, WI 54612-1835 | 2012-11-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396099065 | Gundersen Clinic Ltd | Clinic/Center | 108 S 3rd St, Arcadia, WI 54612 | 2012-11-02 |
| 1972605731 | Alan J Bassuener | Chiropractor | 308 St Joseph Ave Suite 2, Arcadia, WI 54612 | 2006-09-02 |
| 1841231354 | Iwona E Lewis | Physical Therapist | 464 S St Joseph Avenue, Arcadia, WI 54612 | 2006-06-08 |
| 1023008547 | Bert S Hodous | Family Medicine | 895 Dettloff Dr, Arcadia, WI 54612 | 2005-10-26 |
| 1831448299 | Mary A. Green | Nurse Practitioner | 895 Dettloff Dr, Arcadia, WI 54612 | 2012-08-31 |
| 1508937780 | David E Brown | Counselor | 895 Dettloff Dr, Arcadia, WI 54612 | 2006-11-10 |
| 1679510507 | Janet W Butler | Social Worker | 895 Dettloff Dr, Arcadia, WI 54612 | 2006-05-31 |
| 1992700421 | Connie M Hoppe | Nurse Practitioner | 209 N 3rd St, Arcadia, WI 54612-1002 | 2005-06-21 |
| 1962020487 | Robert Burge | Physical Therapy Assistant | 108 Grant St, Arcadia, WI 54612-1206 | 2020-07-10 |
| 1750779013 | Holly Marie Glanville | Registered Nurse | 625 W Main St, Arcadia, WI 54612-1227 | 2015-01-08 |
| Find all providers in zip 54612 | ||||
| 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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| 1326053901 | Chris Cole Pharmacy Inc | Pharmacy | 1887 First Street, Arcadia, LA 71001 | 2006-07-30 |
| 1477598472 | Garfield Beach Cvs LLC | Pharmacy | 1401 S Baldwin Ave, Arcadia, CA 91007-7922 | 2006-06-17 |
| 1871534784 | Garfield Beach Cvs LLC | Pharmacy | 188 Las Tunas Dr, Arcadia, CA 91007-8512 | 2006-06-10 |
| 1962065706 | Medcare Pharmacy and Medical Supply, Inc. | Pharmacy | 289 W Huntington Dr Ste 101, Arcadia, CA 91007-3492 | 2019-04-17 |
| 1700391752 | Life of Hope | Pharmacy | 301 W Huntington Dr Ste 116, Arcadia, CA 91007-3462 | 2017-12-12 |
| 1922418813 | Unicare Pharmacy & Supply Inc | Pharmacy | 289 W Huntington Dr Ste 101, Arcadia, CA 91007-3492 | 2014-05-01 |
| 1699944322 | Arcadia Medical Pharmacy Inc | Pharmacy | 612 W Duarte Rd, Ste 102, Arcadia, CA 91007-7602 | 2008-02-27 |
| 1578749941 | Colonial Pharmacy Inc | Pharmacy | 1326 S Baldwin Ave, Arcadia, CA 91007-7512 | 2008-01-16 |
| Find all providers in ARCADIA | ||||
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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.