Shopko Institutional Care Services Co LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

9041042 Issued in WI

Legal business name

SHOPKO INSTITUTIONAL CARE SERVICES CO LLC

Doing business as

Shopko RxCare

Practice address

3701 E Evergreen Dr
Ste 1000
Appleton, WI 54913-7402

Phone

(920) 739-7855

Fax

(920) 739-3922

NPI assigned

Oct 21, 2010

Organization subpart

No

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

Authorized official

Name

Mr. Michael Bettiga, RPH

Title

Executive Vice President and Coo

Phone

(920) 429-4297

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Shopko RxCare Doing business as

Member of 1

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

• Shopko Stores Operating Co LLC

  dba Shopko Pharmacy 526

  • 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": "1287619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320105600000",
    "number": "1053621243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3701 E EVERGREEN DR",
            "address_2": "STE 1000",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549137402",
            "telephone_number": "920-739-7855",
            "fax_number": "920-739-3922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3701 E EVERGREEN DR",
            "address_2": "STE 1000",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549137402",
            "telephone_number": "920-739-7855",
            "fax_number": "920-739-3922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO INSTITUTIONAL CARE SERVICES CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-21",
        "last_updated": "2011-11-01",
        "status": "A",
        "authorized_official_last_name": "BETTIGA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT AND COO",
        "authorized_official_telephone_number": "920-429-4297",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "WI",
            "license": "9041042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053621243",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053621243",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shopko RxCare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sherman Counseling Management, S.C. (Sherman Counseling Management)
• David Shinkunas, DO
• Stephanie Shirey
• Paul S Shoberg, DO
• Cheryl Lynn Shockey, R.D., M.S.
• Shopko Stores Operating Co LLC (ShopKo Optical 504)
• Shopko Stores Operating Co LLC (ShopKo Pharmacy 505)
• Shopko Stores Operating Co LLC (ShopKo Pharmacy 504)
• Shopko Stores Operating Co LLC (ShopKo Pharmacy 015)
• Shopko Stores Operating Co LLC (Shopko Eyecare Center 4505)

• Long Term Care Pharmacy in Appleton, WI
• Providers in Appleton, WI by specialty
• Long Term Care Pharmacy in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2011; 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.