Shopko Stores Operating Co LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301008354 Issued in MI

Legal business name

SHOPKO STORES OPERATING CO LLC

Practice address

1150 W Washington St
Marquette, MI 49855-4040

Phone

(906) 228-8380

Fax

(906) 228-3565

NPI assigned

May 10, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Russell Steinhorst

Title

SVP and Cfo

Phone

(920) 429-7489

Specialties & licenses 3

Addresses

Other identifiers 5

Other names 1

• ShopKo Pharmacy 2010 Doing business as

Locations

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450137600000",
    "number": "1104875731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 W WASHINGTON ST",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498554040",
            "telephone_number": "906-228-8380",
            "fax_number": "906-228-3565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 W WASHINGTON ST",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498554040",
            "telephone_number": "906-228-8380",
            "fax_number": "906-228-3565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2015-12-15",
        "status": "A",
        "authorized_official_last_name": "STEINHORST",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_title_or_position": "SVP AND CFO",
        "authorized_official_telephone_number": "920-429-7489",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MI",
            "license": "5301008354",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "2306909",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PIN",
            "identifier": "9000E210860",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2306909",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MI MEDICAID DME",
            "identifier": "4913356",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MI MEDICAID DME",
            "identifier": "4819069",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ShopKo Pharmacy 2010",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Peter Michael Shelafoe, LMSW
• Shelton Professional Phlebotomy Services LLC
• Jamie Lynn Shelton, PHLEB
• Jeffrey M Shipkey, D.O.
• Kellie Eileen Shipkey, NP
• Shopko Stores Operating Co. LLC
• Shoptikal LLC
• Shoreline Supportive Counseling PLLC
• Martha J Short, M.D.
• William M Short, MD

• Community/Retail Pharmacy in Marquette, MI
• Providers in Marquette, MI by specialty
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2015; 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.