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SHOPKO STORES OPERATING CO LLC NPI 1790711737


NPI Information

NPI: 1790711737
Provider Name: SHOPKO STORES OPERATING CO LLC

Doing Business As: SHOPKO PHARMACY 150

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

Address:
3030 WABASH AVE
SPRINGFIELD, IL
ZIP 62704
Phone: (217) 698-9614
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SHOPKO STORES OPERATING CO LLC is a community/retail pharmacy pharmacy in Springfield, IL. 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 1790711737. The provider is registered as an organization entity type.
The provider Is Doing Business As Shopko Pharmacy 150.

The provider's business location address is:

3030 WABASH AVE
SPRINGFIELD, IL
ZIP 62704-413
Phone: (217) 698-9614
Fax: (217) 546-1761

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 6/23/2006 and was last updated on 8/14/2008.


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
23336C0003XPharmacyCommunity/Retail Pharmacy054015896ILLINOISYes

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
11249550005MEDICARE ID-TYPE UNSPECIFIED
21468708OTHERNCPDP NUMBER
35695760135MEDICARE ID-TYPE UNSPECIFIED
4371110040150MEDICAIDILLINOIS
5=========013MEDICAIDILLINOIS
65695760135MEDICARE NSC

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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