Shopko Stores Operating Co LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

SHOPKO STORES OPERATING CO LLC

Practice address

406 Gateway Ave
Mauston, WI 53948-1401

Phone

(608) 350-0962

NPI assigned

May 4, 2016

Organization subpart

No

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

Authorized official

Name

Lorie Neumann

Title

Director of Third Party

Phone

(920) 429-4726

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• SHOPKO PHARMACY 563 Doing business as

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

{
    "created_epoch": "1462320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481760000000",
    "number": "1124473533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 GATEWAY AVE",
            "city": "MAUSTON",
            "state": "WI",
            "postal_code": "539481401",
            "telephone_number": "608-350-0962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 GATEWAY AVE",
            "city": "MAUSTON",
            "state": "WI",
            "postal_code": "539481401",
            "telephone_number": "608-350-0962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-04",
        "last_updated": "2016-12-15",
        "status": "A",
        "authorized_official_last_name": "NEUMANN",
        "authorized_official_first_name": "LORIE",
        "authorized_official_title_or_position": "DIRECTOR OF THIRD PARTY",
        "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124473533",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SHOPKO PHARMACY 563",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brian Scott Schultz, DO
• Jenna K. Sebranek, MD
• Kayla Marie Seitz, LCSW
• Erin Severson
• Lori Sherman, RDH
• Barrett E Shoults, MD
• Donna Sue Shuck, DIETITIAN B.S.
• Cory Siegrist, ATC
• Kendall Erin Simmons, OTR/L, CLT
• Mariah Soderling, SAC

• Community/Retail Pharmacy in Mauston, WI
• Providers in Mauston, WI by specialty
• Community/Retail Pharmacy in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2016; 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.