NPIMap

Organization Active NPI

Shopko Stores Operating Co LLC

Doing business as ShopKo Pharmacy 083

  • Community/Retail Pharmacy
  • Sandy, UT
National Provider Identifier
1295786572
Registry record updated Aug 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
1313211703 Issued in UT
Legal business name
SHOPKO STORES OPERATING CO LLC
Doing business as
ShopKo Pharmacy 083
Practice address
2165 E 9400 S
Sandy, UT 84093-3201
Phone
(801) 942-8555
Fax
(801) 943-9121
NPI assigned
May 12, 2006
Last updated
Aug 29, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2016

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

Authorized official

Name
Mr. Russell Steinhorst
Title
SVP Chief Financial Officer
Phone
(920) 429-7489

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Eyewear Supplier 332H00000X
Community/Retail Pharmacy 3336C0003X 1313211703 UT Primary

Addresses

Primary practice location

2165 E 9400 S
Sandy, UT 84093-3201

Mailing address

2165 E 9400 S
Sandy, UT 84093-3201
Phone (801) 942-8555

Other identifiers 2

IdentifierTypeStateIssuer
4606692OtherNCPDP NUMBER
410985054019MedicaidUT

Other names 1

  • ShopKo Pharmacy 083 Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472428800000",
    "number": "1295786572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2165 E 9400 S",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840933201",
            "telephone_number": "801-942-8555",
            "fax_number": "801-943-9121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2165 E 9400 S",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840933201",
            "telephone_number": "801-942-8555",
            "fax_number": "801-943-9121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2016-08-29",
        "status": "A",
        "authorized_official_last_name": "STEINHORST",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_title_or_position": "SVP CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "920-429-7489",
        "authorized_official_name_prefix": "Mr."
    },
    "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": "UT",
            "license": "1313211703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "4606692",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "410985054019",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ShopKo Pharmacy 083",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sandy, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 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.