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SHOPKO STORES OPERATING CO LLC NPI 1134172794


NPI Information

NPI: 1134172794
Provider Name: SHOPKO STORES OPERATING CO LLC

Doing Business As: SHOPKO PHARMACY 2653

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

Address:
174 JAMES ROBERTSON DR
GLADWIN, MI
ZIP 48624
Phone: (989) 426-7020
Get Directions

SHOPKO STORES OPERATING CO LLC is a community/retail pharmacy pharmacy in Gladwin, MI. The provider is 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. SHOPKO STORES OPERATING CO LLC NPI is 1134172794. The provider is registered as an organization entity type.
The provider Is Doing Business As Shopko Pharmacy 2653.

The provider's business location address is:

174 JAMES ROBERTSON DR
GLADWIN, MI
ZIP 48624-006
Phone: (989) 426-7020
Fax: (989) 426-7155

The provider's authorized official is Russell Steinhorst .
The authorized official title is Svp And Coo and has the following contact phone number (920) 429-7489.

The enumeration date for this NPI number is 5/17/2006 and was last updated on 12/14/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1333600000XPharmacyNo
2332B00000XDurable Medical Equipment & Medical SuppliesNo
33336C0003XPharmacyCommunity/Retail PharmacyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
12355661MEDICAIDMICHIGAN
20P42860MEDICARE PIN
32355661OTHERNCPDP NUMBER
43247754MEDICAIDMICHIGAN
55695760219MEDICARE NSC
60459230053MEDICARE ID-TYPE UNSPECIFIED
74913866MEDICAIDMICHIGAN
84819283MEDICAIDMICHIGAN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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