Shopko Stores Operating Co., LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

SHOPKO STORES OPERATING CO., LLC

Practice address

440 W Main St
Tremonton, UT 84337

Phone

(920) 429-4726

NPI assigned

Aug 10, 2015

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

Dir 3D Party Contract & Ca

Phone

(920) 429-4726

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Shopko Pharmacy #2799 Doing business as

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

{
    "created_epoch": "1439164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450828800000",
    "number": "1366828642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 W MAIN ST",
            "city": "TREMONTON",
            "state": "UT",
            "postal_code": "84337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 W MAIN ST",
            "city": "TREMONTON",
            "state": "UT",
            "postal_code": "84337",
            "telephone_number": "920-429-4726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-10",
        "last_updated": "2015-12-23",
        "status": "A",
        "authorized_official_last_name": "NEUMANN",
        "authorized_official_first_name": "LORIE",
        "authorized_official_title_or_position": "DIR 3D PARTY CONTRACT & CA",
        "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": "1366828642",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shopko Pharmacy #2799",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Tamara S Shannon, CMA AAMA
• Gary Graham Shaw, DDS
• Zachary Smith, PA
• Laura E. Spall, FNP-C
• Spoiled Energy and Day Spa Inc.
• Tina Marie Stokes
• Layne T Summers

• Community/Retail Pharmacy in Tremonton, UT
• Providers in Tremonton, UT by specialty
• Community/Retail Pharmacy in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2015; 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.