NPIMap

Organization Active NPI

Shopko Stores Operating Co., LLC

Doing business as Shopko Pharmacy 2215

  • Community/Retail Pharmacy
  • Shawano, WI
National Provider Identifier
1003349101
Registry record updated Apr 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
SHOPKO STORES OPERATING CO., LLC
Doing business as
Shopko Pharmacy 2215
Practice address
100 County Road B
Shawano, WI 54166-7072
Phone
(920) 429-4726
NPI assigned
Apr 5, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jannie Delane Paschal
Title
VP Managed Care
Phone
(920) 429-4726

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

100 County Road B
Shawano, WI 54166-7072

Mailing address

100 County Road B Ste W181
Shawano, WI 54166-7072
Phone (715) 526-3456

Other identifiers 1

IdentifierTypeStateIssuer
1003349101MedicaidWI

Other names 1

  • Shopko Pharmacy 2215 Doing business as

National Provider Directory

National Provider Directory

Member organizations 90

Organizations listed as members of this organization in the National Provider Directory.

View all 90

Locations

100 County Road B
Ste W181
Shawano, WI 54166
Phone (715) 526-3456

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1491350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524787200000",
    "number": "1003349101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 COUNTY ROAD B STE W181",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "541667072",
            "telephone_number": "715-526-3456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 COUNTY ROAD B",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "541667072",
            "telephone_number": "920-429-4726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-05",
        "last_updated": "2018-04-27",
        "status": "A",
        "authorized_official_last_name": "PASCHAL",
        "authorized_official_first_name": "JANNIE",
        "authorized_official_middle_name": "DELANE",
        "authorized_official_title_or_position": "VP MANAGED CARE",
        "authorized_official_telephone_number": "920-429-4726"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003349101",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shopko Pharmacy 2215",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shopko Pharmacy 2215",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shawano, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.