NPIMap

Organization Active NPI

Shopko #602

  • Pharmacy
  • Oconto, WI
National Provider Identifier
1265878110
Registry record updated May 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
900542 Issued in WI
Legal business name
SHOPKO #602
Practice address
126 Charles St
Oconto, WI 54153-9446
Phone
(920) 834-5251
Fax
(920) 834-9801
NPI assigned
May 20, 2013
Last updated
May 20, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2013

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

Authorized official

Name
Mr. Nick Jackson Jr., R.PH.
Title
Pharmacy Manager
Phone
(920) 834-5251

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 900542 WI Primary

Addresses

Primary practice location

126 Charles St
Oconto, WI 54153-9446

Mailing address

126 Charles St
Oconto, WI 54153-9446
Phone (920) 834-5251

National Provider Directory

National Provider Directory
Tax ID family
Shopko Stores Operating LLC16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1369008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369008000000",
    "number": "1265878110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 CHARLES ST",
            "city": "OCONTO",
            "state": "WI",
            "postal_code": "541539446",
            "telephone_number": "920-834-5251",
            "fax_number": "920-834-9801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 CHARLES ST",
            "city": "OCONTO",
            "state": "WI",
            "postal_code": "541539446",
            "telephone_number": "920-834-5251",
            "fax_number": "920-834-9801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO #602",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-20",
        "last_updated": "2013-05-20",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "NICK",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "920-834-5251",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "WI",
            "license": "900542",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oconto, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 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.