NPIMap

Organization Active NPI

Shopko

  • Community/Retail Pharmacy
  • Green Bay, WI
National Provider Identifier
1184051948
Registry record updated Oct 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
051-039854 Issued in WI
Legal business name
SHOPKO
Practice address
301 Bay Park SQ
Green Bay, WI 54304-5104
Phone
(920) 499-5889
NPI assigned
Oct 10, 2013
Last updated
Oct 10, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2013

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

Authorized official

Name
Gena TrastNPI 1962833301
Title
Pharmacist
Phone
(920) 499-5889

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 051-039854 WI Primary

Addresses

Primary practice location

301 Bay Park SQ
Green Bay, WI 54304-5104

Mailing address

301 Bay Park SQ
Green Bay, WI 54304-5104
Phone (920) 499-5889

National Provider Directory

National Provider Directory
Tax ID family
Shopko2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1381363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381363200000",
    "number": "1184051948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 BAY PARK SQ",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045104",
            "telephone_number": "920-499-5889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 BAY PARK SQ",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045104",
            "telephone_number": "920-499-5889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-10",
        "last_updated": "2013-10-10",
        "status": "A",
        "authorized_official_last_name": "TRAST",
        "authorized_official_first_name": "GENA",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "920-499-5889"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "051-039854",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2013; 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.