SHOPKO STORES OPERATING CO LLC (NPI# 1992756084) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992756084 |
| Entity Type | Organization |
| Organization Name | SHOPKO STORES OPERATING CO LLC |
| Other Organization Name | SHOPKO PHARMACY 053 |
| Practice Address |
510 E Philip Ave North Platte NE 69101-5538 |
| Practice Telephone | 3085347353 |
| Practice Fax Number | 3085342625 |
| Mailing Telephone | 3085347353 |
| Mailing Fax Number | 3085342625 |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2013-10-28 |
| 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 |
2682 | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NCPDP NUMBER | 2812748 | 01 | |
| NE | 10025414300 | 05 | |
| NE | 41098505415 | 05 |
| Other Name | Type Code |
|---|---|
| ShopKo Pharmacy 053 | 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 |
510 E PHILIP AVE |
| City | NORTH PLATTE |
| State | NE |
| Zip Code | 69101-5538 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295264547 | Kelly Mccarthy | Optometrist | 510 E Philip Ave, North Platte, NE 69101-5538 | 2017-06-09 |
| 1184976425 | Karl Thomas Jepson | Optometrist | 510 E Philip Ave, North Platte, NE 69101-5538 | 2012-10-10 |
| 1235275983 | Jason L Hawley | Optometrist | 510 E Philip Ave, North Platte, NE 69101-5538 | 2007-01-29 |
| 1922045616 | John L Dorwart | Optometrist | 510 E Philip Ave, North Platte, NE 69101-5538 | 2006-06-01 |
| 1336191501 | Shopko Stores Operating Co. LLC | Eyewear Supplier (Equipment, not the service) | 510 E Philip Ave, North Platte, NE 69101-5538 | 2006-05-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972017523 | Rocky Mountain Holdings, LLC | Ambulance | 5570 E. Lee Bird Drive, Northe Platte, NE 69101 | 2017-11-18 |
| 1396297503 | Karen L Gutherless | Counselor | 401 W Walker Road, North Platte, NE 69101 | 2016-11-04 |
| 1992165898 | Laren Alden Roper Jr. | Occupational Therapist | 1115 S Cottonwood, Great Plains Sports and Therapy Center, North Platte, NE 69101 | 2016-03-04 |
| 1669733085 | Stephanie Lynn Marcy | Anesthesiology | 601 W Leota Street, Anes: Anesthesiology, North Platte, NE 69101 | 2012-06-01 |
| 1033480470 | Wb Counseling LLC | Counselor | 319 E. B St., North Platte, NE 69101 | 2012-01-17 |
| 1306114962 | Amy J Kloess | Occupational Therapist | 8165 North Twin Lakes Rd, North Platte, NE 69101 | 2011-12-09 |
| 1043442312 | Derek Walrod | Dentist | 1225 South Poplar, Suite 500, North Platte, NE 69101 | 2009-08-20 |
| 1033374525 | Millie Erickson | Urology | 611 W. Francis St., Suite 200, North Platte, NE 69101 | 2008-07-23 |
| 1952586331 | West Central District Health Department | Public Health or Welfare | 111 North Dewey Street, North Platte, NE 69101 | 2008-01-04 |
| 1558579698 | Piper Dental Clinic | Dentist | 1919 West A Street, North Platte, NE 69101 | 2007-05-21 |
| Find all providers in zip 69101 | ||||
| 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 |
|---|---|---|---|---|
| 1053403139 | North Platte Pharmacy Inc | Pharmacy | 211 W Leota St, North Platte, NE 69101-6103 | 2006-09-28 |
| 1962594044 | Usprx, Inc | Pharmacy | 402 N Jeffers St, North Platte, NE 69101-3931 | 2006-09-28 |
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| 1083128250 | Innovative Pain & Spine Specialists | Pharmacy | 7121 Stephanie Ln Ste 104, Lincoln, NE 68516-5359 | 2017-11-27 |
| 1225547433 | Costco Wholesale Corportation | Pharmacy | 1620 Pine Lake Road, Lincoln, NE 68512 | 2017-09-20 |
| 1699191734 | Arborpharm, LLC | Pharmacy | 203 S 7th St, Ste B, Wymore, NE 68466 | 2014-03-13 |
| 1982020590 | B&r Stores, Inc | Pharmacy | 611 N Burlington Ave, Hastings, NE 68901-5037 | 2014-03-07 |
| Find all providers with the same taxonomy | ||||
| City | NORTH PLATTE |
| Zip Code | 69101 |
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.