SHOPKO STORES OPERATING CO LLC NPI 1790095099

NPI Information

  • NPI: 1790095099
  • Provider Name: SHOPKO STORES OPERATING CO LLC
  • Classification: Pharmacy - 3336C0003X
  • Specialization: Community/Retail Pharmacy
  • Entity Type: Organization
  • Doing Business As: SHOPKO PHARMACY 607
  • Address: 1010 S MAINLINE DR
    SEYMOUR, WI
    ZIP 54165
  • Phone: (920) 833-0430

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NPI Details

SHOPKO STORES OPERATING CO LLC is a community/retail pharmacy pharmacy in Seymour, WI. 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 1790095099. The provider is registered as an organization entity type.
The provider Is Doing Business As Shopko Pharmacy 607.

The provider's business location address is:

1010 S MAINLINE DR
SEYMOUR, WI
ZIP 54165-150
Phone: (920) 833-0430
Fax: (920) 833-7556

The provider's authorized official is Michael Bettiga .
The authorized official title is Executive Vice President And Coo and has the following contact phone number (920) 429-4297.

The enumeration date for this NPI number is 10/20/2010 and was last updated on 12/9/2011.

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
2333600000XPharmacyNo
3332H00000XEyewear SupplierNo
43336C0003XPharmacyCommunity/Retail PharmacyYes

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
15695760148MEDICARE NSCWISCONSIN
21790095099MEDICAIDWISCONSIN

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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