SHOPKO STORES OPERATING CO LLC NPI 1639121155

NPI Information

  • NPI: 1639121155
  • Provider Name: SHOPKO STORES OPERATING CO LLC
  • Classification: Pharmacy - 3336C0003X
  • Specialization: Community/Retail Pharmacy
  • Entity Type: Organization
  • Doing Business As: SHOPKO PHARMACY 111
  • Address: 1230 LANCASTER DR SE
    SALEM, OR
    ZIP 97317
  • Phone: (503) 371-6830

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NPI Details

SHOPKO STORES OPERATING CO LLC is a community/retail pharmacy pharmacy in Salem, OR. 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 1639121155. The provider is registered as an organization entity type.
The provider Is Doing Business As Shopko Pharmacy 111.

The provider's business location address is:

1230 LANCASTER DR SE
SALEM, OR
ZIP 97317-800
Phone: (503) 371-6830
Fax: (503) 371-8159

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 5/16/2006 and was last updated on 4/6/2016.

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
1332B00000XDurable Medical Equipment & Medical SuppliesNo
2332H00000XEyewear SupplierNo
33336C0003XPharmacyCommunity/Retail Pharmacy1193OREGONYes

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
1278347MEDICAIDOREGON
2038658MEDICAIDOREGON
3278380MEDICAIDOREGON
43810721OTHERNCPDP NUMBER
55695760009MEDICARE NSC
6R142271MEDICARE PINOREGON

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: 11/21/2025

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