Shopko Stores Operating Co LLC

Key facts

NPI: 1124420666
Entity type: Organization (NPI type 2)
Primary specialty: Community/Retail Pharmacy 3336C0003X
Legal business name: SHOPKO STORES OPERATING CO LLC
Practice address: 301 S Mantorville Ave
Kasson, MN 55944
Phone: (507) 634-7798
Fax: (507) 634-2103
NPI assigned: Sep 16, 2014
Organization subpart: No

Authorized official

Name: Lorie Neumann
Title: VP Retail Health Services
Phone: (920) 429-4726

National Provider Directory

Specialties & licenses

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

Addresses

Primary practice location

301 S Mantorville Ave
Kasson, MN 55944

Mailing address

301 S Mantorville Ave
Kasson, MN 55944

Other names

SHOPKO PHARMACY 796 Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 28, 2014.

{
    "created_epoch": "1410825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414454400000",
    "number": "1124420666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 S MANTORVILLE AVE",
            "city": "KASSON",
            "state": "MN",
            "postal_code": "55944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 S MANTORVILLE AVE",
            "city": "KASSON",
            "state": "MN",
            "postal_code": "55944",
            "telephone_number": "507-634-7798",
            "fax_number": "507-634-2103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-16",
        "last_updated": "2014-10-28",
        "status": "A",
        "authorized_official_last_name": "NEUMANN",
        "authorized_official_first_name": "LORIE",
        "authorized_official_title_or_position": "VP RETAIL HEALTH SERVICES",
        "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SHOPKO PHARMACY 796",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kasson, MN

All providers in Kasson, MN · Community/Retail Pharmacy in Minnesota

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 28, 2014. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.