SHOPKO STORES OPERATING CO LLC (NPI# 1982922860) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982922860 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 602 |
| Practice Address |
126 Charles St Oconto WI 54153-9446 |
| Practice Telephone | 9208349800 |
| Practice Fax Number | 9208349801 |
| Mailing Telephone | 9208349800 |
| Mailing Fax Number | 9208349801 |
| Enumeration Date | 2010-05-17 |
| Last Update Date | 2011-07-26 |
| Authorized Official Name | MR. MICHAEL BETTIGA (EXECUTIVE VICE PRESIDENT AND 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 | ||
| N | 332H00000X | Eyewear Supplier (Equipment, not the service) | 456-1020161146-0 | WI | Suppliers |
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
9005-042 | WI | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 1982922860 | 05 |
| Other Name | Type Code |
|---|---|
| ShopKo Pharmacy 602 | 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 |
126 CHARLES ST |
| City | OCONTO |
| State | WI |
| Zip Code | 54153-9446 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194155267 | Thomas Lotter Sr. | Pharmacist | 126 Charles St, Oconto, WI 54153-9446 | 2013-11-26 |
| 1265878110 | Shopko #602 | Pharmacy | 126 Charles St, Oconto, WI 54153-9446 | 2013-05-20 |
| 1154617652 | Jaclyn Ann Keller | Optometrist | 126 Charles St, Oconto, WI 54153-9446 | 2011-06-22 |
| 1346569183 | Shopko Stores Operating Co LLC | Eyewear Supplier (Equipment, not the service) | 126 Charles St, Oconto, WI 54153-9446 | 2010-05-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629240650 | Aurora Medical Group Inc | Durable Medical Equipment & Medical Supplies | 530 Smith Ave, Oconto, WI 54153 | 2008-03-31 |
| 1912997081 | Benzer Wi 1 LLC | Pharmacy | 1008 Main St, Oconto, WI 54153 | 2005-10-28 |
| 1245758127 | Hayley Joy Maxwell | Counselor | 501 Park Ave, Oconto, WI 54153 | 2017-08-31 |
| 1538542089 | Aliaksandr Trusau | Internal Medicine | 620 Smith Ave, Oconto, WI 54153 | 2015-07-01 |
| 1467879296 | Christopher Hanke | Counselor | 501 Park Ave, Oconto, WI 54153 | 2014-03-18 |
| 1669807020 | Joshua Ammon Weenig | Dentist | 1210 Pecor St, Oconto, WI 54153 | 2013-09-04 |
| 1609050798 | Bellin Psychiatric Center Inc | Clinic/Center | 820 Arbutus Ave, Oconto, WI 54153 | 2007-12-26 |
| 1932252533 | Oconto County Health & Human Services | Registered Nurse | 501 Park Ave, Oconto, WI 54153 | 2007-01-19 |
| 1841343449 | Oconto County Health & Human Services | Hospice Care, Community Based | 501 Park Ave, Oconto, WI 54153 | 2007-01-19 |
| 1457425951 | Lori Jo Eklund Walsh | Counselor | 820 Arbutus Ave, Oconto, WI 54153 | 2006-11-17 |
| Find all providers in zip 54153 | ||||
| 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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| 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.