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SHOPKO STORES OPERATING CO LLC NPI 1295780815


NPI Information

NPI: 1295780815
Provider Name: SHOPKO STORES OPERATING CO LLC

Doing Business As: SHOPKO PHARMACY 064

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

Address:
2100 CALDWELL BLVD
NAMPA, ID
ZIP 83651
Phone: (208) 466-9616
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SHOPKO STORES OPERATING CO LLC is a community/retail pharmacy pharmacy in Nampa, 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 1295780815. The provider is registered as an organization entity type.
The provider Is Doing Business As Shopko Pharmacy 064.

The provider's business location address is:

2100 CALDWELL BLVD
NAMPA, ID
ZIP 83651-510
Phone: (208) 466-9616
Fax: (208) 463-1724

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 7/25/2014.


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
1333600000XPharmacy2042CPIDAHONo
2332B00000XDurable Medical Equipment & Medical SuppliesNo
3332H00000XEyewear SupplierNo
43336C0003XPharmacyCommunity/Retail Pharmacy2042CPIDAHOYes

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
11111590020MEDICARE ID-TYPE UNSPECIFIED
2000311800MEDICAIDIDAHO
30193994OTHERWA LABOR & INDUSTRY
45695760006MEDICARE NSC
50215801OTHERWA LABOR & INDUSTRY
61304524OTHERNCPDP NUMBER

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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