Pamida Stores Operating Co LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

262779-5 Issued in MN

Legal business name

PAMIDA STORES OPERATING CO LLC

Practice address

705 Northland Dr
Princeton, MN 55371-2168

Phone

(763) 389-3111

Fax

(763) 389-1621

NPI assigned

May 18, 2006

Organization subpart

No

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

Authorized official

Name

Mr. John Harlow

Title

Ceo/President

Phone

(402) 596-7206

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• Pamida Pharmacy 335 Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Shopko Stores Operating Co LLC

  • Community/Retail Pharmacy
  • Afton, WY
  • NPI 1891971719

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258934400000",
    "number": "1003869272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 NORTHLAND DR",
            "city": "PRINCETON",
            "state": "MN",
            "postal_code": "553712168",
            "telephone_number": "763-389-3111",
            "fax_number": "763-389-1621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 NORTHLAND DR",
            "city": "PRINCETON",
            "state": "MN",
            "postal_code": "553712168",
            "telephone_number": "763-389-3111",
            "fax_number": "763-389-1621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAMIDA STORES OPERATING CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2009-11-23",
        "status": "A",
        "authorized_official_last_name": "HARLOW",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "402-596-7206",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "262779-5",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "848647000",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "510864100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2420836",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pamida Pharmacy 335",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jane E. Odgers, D.D.S
• Rachel Olsen, DO
• Sandra Olson Larson, MSW
• Arthur Randal Olson, MD
• Elisabeth Palmer
• Pamela Jean Parson, C.M.P.
• Trista Adele Paulson, LPCC
• Yuliya V Perepelitsa, M.D.
• Breanna Peterson, D.O.
• Elizabeth Joanne Peterson, MD

• Community/Retail Pharmacy in Princeton, MN
• Providers in Princeton, MN by specialty
• Community/Retail Pharmacy in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2009; 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.