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SHOPKO STORES OPERATING CO LLC NPI 1144275884


NPI Information

NPI: 1144275884
Provider Name: SHOPKO STORES OPERATING CO LLC

Doing Business As: SHOPKO PHARMACY 072

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

Address:
2120 THAIN GRADE
LEWISTON, ID
ZIP 83501
Phone: (208) 746-1044
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SHOPKO STORES OPERATING CO LLC is a community/retail pharmacy pharmacy in Lewiston, 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 1144275884. The provider is registered as an organization entity type.
The provider Is Doing Business As Shopko Pharmacy 072.

The provider's business location address is:

2120 THAIN GRADE
LEWISTON, ID
ZIP 83501-105
Phone: (208) 746-1044
Fax: (208) 746-0744

The provider's authorized official is Michael 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 5/23/2006 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
2333600000XPharmacy2036CPIDAHONo
3332H00000XEyewear SupplierNo
43336C0003XPharmacyCommunity/Retail Pharmacy2036CPIDAHOYes

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
10215803OTHERWA LABOR & INDUSTRY
2806730900MEDICAIDIDAHO
31111590032MEDICARE ID-TYPE UNSPECIFIED
41304651OTHERNCPDP NUMBER
55695760098MEDICARE NSC
60004888OTHERWA LABOR & INDUSTRY
7000311600MEDICAIDIDAHO

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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