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SHOPKO STORES OPERATING CO LLC NPI 1164477881


NPI Information

NPI: 1164477881
Provider Name: SHOPKO STORES OPERATING CO LLC

Doing Business As: SHOPKO PHARMACY 069

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

Address:
217 W IRONWOOD DR
COEUR D ALENE, ID
ZIP 83814
Phone: (208) 765-9586
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SHOPKO STORES OPERATING CO LLC is a community/retail pharmacy pharmacy in Coeur D Alene, ID. 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 1164477881. The provider is registered as an organization entity type.
The provider Is Doing Business As Shopko Pharmacy 069.

The provider's business location address is:

217 W IRONWOOD DR
COEUR D ALENE, ID
ZIP 83814-651
Phone: (208) 765-9586
Fax: (208) 765-6922

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

The enumeration date for this NPI number is 5/23/2006 and was last updated on 12/10/2015.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1333600000XPharmacy2037CPIDAHONo
2332B00000XDurable Medical Equipment & Medical SuppliesNo
3332H00000XEyewear SupplierNo
43336C0003XPharmacyCommunity/Retail Pharmacy2037CPIDAHOYes

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 IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
10034347OTHERWA LABOR & INDUSTRY
2000123200MEDICAIDIDAHO
30215806OTHERWA LABOR & INDUSTRY
41304613OTHERNCPDP NUMBER
51111590018MEDICARE ID-TYPE UNSPECIFIED
6000123100MEDICAIDIDAHO
75695760099MEDICARE NSC

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: 4/28/2024

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