Shopko Stores Operating Co LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

5301008360 Issued in MI

Legal business name

SHOPKO STORES OPERATING CO LLC

Practice address

2530 1St Ave N
Escanaba, MI 49829-1390

Phone

(906) 786-2011

Fax

(906) 786-2816

NPI assigned

May 12, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Russell Steinhorst

Title

SVP and Cfo

Phone

(920) 429-7489

Specialties & licenses 3

Addresses

Other identifiers 5

Other names 1

• ShopKo Pharmacy 2016 Doing business as

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450051200000",
    "number": "1396796892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2530 1ST AVE N",
            "city": "ESCANABA",
            "state": "MI",
            "postal_code": "498291390",
            "telephone_number": "906-786-2011",
            "fax_number": "906-786-2816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 1ST AVE N",
            "city": "ESCANABA",
            "state": "MI",
            "postal_code": "498291390",
            "telephone_number": "906-786-2011",
            "fax_number": "906-786-2816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2015-12-14",
        "status": "A",
        "authorized_official_last_name": "STEINHORST",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_title_or_position": "SVP AND CFO",
        "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": "MI",
            "license": "5301008360",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MI MEDICAID DME",
            "identifier": "4819040",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MI MEDICAID DME",
            "identifier": "4913383",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2341763",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PIN",
            "identifier": "9000B11041",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP #",
            "identifier": "2341763",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ShopKo Pharmacy 2016",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amber Schram
• James Schwake II, LMSW
• Sarah Elizabeth Seder, PHARMD
• Kelsey Segerstrom
• Ronald J Sherman, D.O.
• Shopko Stores Operating Co. LLC
• Shoptikal LLC
• Corydon Walter Siffring, MD
• Rebecca Ann Sliva, RN
• Smileselect.Dental PLLC

• Community/Retail Pharmacy in Escanaba, MI
• Providers in Escanaba, MI by specialty
• Community/Retail Pharmacy in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 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.