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SHOPKO STORES OPERATING CO LLC NPI 1407807118


NPI Information

NPI: 1407807118
Provider Name: SHOPKO STORES OPERATING CO LLC

Doing Business As: SHOPKO PHARMACY 040

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

Address:
3025 HAMILTON BLVD
SIOUX CITY, IA
ZIP 51104
Phone: (712) 255-8055
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SHOPKO STORES OPERATING CO LLC is a community/retail pharmacy pharmacy in Sioux City, IA. 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 1407807118. The provider is registered as an organization entity type.
The provider Is Doing Business As Shopko Pharmacy 040.

The provider's business location address is:

3025 HAMILTON BLVD
SIOUX CITY, IA
ZIP 51104-407
Phone: (712) 255-8055
Fax: (712) 255-4784

The provider's authorized official is Micael J Bettiga .
The authorized official title is Sr. Vice President Health Services and has the following contact phone number (920) 429-4297.

The enumeration date for this NPI number is 5/15/2006 and was last updated on 6/6/2014.


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
1332B00000XDurable Medical Equipment & Medical SuppliesNo
2332H00000XEyewear SupplierNo
33336C0003XPharmacyCommunity/Retail Pharmacy514IOWAYes

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
19164712MEDICAIDSOUTH DAKOTA
20208470MEDICAIDIOWA
35695760114MEDICARE NSC
441098505408MEDICAIDNEBRASKA
58531560MEDICAIDSOUTH DAKOTA
65695760114MEDICARE ID-TYPE UNSPECIFIED
70154160094MEDICARE ID-TYPE UNSPECIFIED
81613531OTHERNCPDP NUMBER
910025413500MEDICAIDNEBRASKA
108531562MEDICAIDSOUTH DAKOTA
110495028MEDICAIDIOWA

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: 11/14/2023

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