Shopko Stores Operating Co LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

1197 Issued in MT

Legal business name

SHOPKO STORES OPERATING CO LLC

Doing business as

ShopKo Pharmacy 112

Practice address

3101 N Montana Ave
Helena, MT 59602

Phone

(406) 443-8823

Fax

(406) 443-2282

NPI assigned

May 19, 2006

Last updated

Jul 25, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dilip Sedani

Title

VP Managed Health Care

Phone

(920) 429-7688

Specialties & licenses 3

Addresses

Other identifiers 5

Other names 1

• ShopKo Pharmacy 112 Doing business as

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532476800000",
    "number": "1124072921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3101 N MONTANA AVE",
            "city": "HELENA",
            "state": "MT",
            "postal_code": "596027813",
            "telephone_number": "406-443-8823",
            "fax_number": "406-443-2282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3101 N MONTANA AVE",
            "city": "HELENA",
            "state": "MT",
            "postal_code": "59602",
            "telephone_number": "406-443-8823",
            "fax_number": "406-443-2282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2018-07-25",
        "status": "A",
        "authorized_official_last_name": "SEDANI",
        "authorized_official_first_name": "DILIP",
        "authorized_official_title_or_position": "VP MANAGED HEALTH CARE",
        "authorized_official_telephone_number": "920-429-7688"
    },
    "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": "MT",
            "license": "1197",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5607331",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0213577",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0230435",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5607909",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "2705018",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ShopKo Pharmacy 112",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ShopKo Pharmacy 112",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Deanna Sherman
• Stefani R Sherman, APRN
• Traci L Shinabarger, LCSW, MPA, BCBA
• Jeff W Shirley, DPT
• Kevin M Shon, LCSW
• Shopko Stores Operating Co. LLC (ShopKo Optical 112)
• Randy R. Sibbitt, M.D.
• Amy Sierer
• David W Silk, MD
• Catherine Clare Silva, APRN

• Community/Retail Pharmacy in Helena, MT
• Providers in Helena, MT by specialty
• Community/Retail Pharmacy in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 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.