Pamida Stores Operating Co LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

8590042 Issued in WI

Legal business name

PAMIDA STORES OPERATING CO LLC

Doing business as

Pamida Pharmacy 108

Practice address

1011 E Spruce St
Abbotsford, WI 54405-9647

Phone

(715) 223-2480

Fax

(715) 223-2663

NPI assigned

May 20, 2006

Organization subpart

No

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

Authorized official

Name

Mr. John Harlow

Title

Ceo/President

Phone

(402) 596-7206

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Pamida Pharmacy 108 Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Shopko Stores Operating Co LLC

  • Community/Retail Pharmacy
  • Afton, WY
  • NPI 1891971719

  Member Of

  NPD member

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258934400000",
    "number": "1407800634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 E SPRUCE ST",
            "city": "ABBOTSFORD",
            "state": "WI",
            "postal_code": "544059647",
            "telephone_number": "715-223-2480",
            "fax_number": "715-223-2663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 E SPRUCE ST",
            "city": "ABBOTSFORD",
            "state": "WI",
            "postal_code": "544059647",
            "telephone_number": "715-223-2480",
            "fax_number": "715-223-2663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAMIDA STORES OPERATING CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-20",
        "last_updated": "2009-11-23",
        "status": "A",
        "authorized_official_last_name": "HARLOW",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "402-596-7206",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "8590042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "5127483",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33270500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pamida Pharmacy 108",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brittany Koplitz, LPC-IT, SAC-IT
• Matthew James Kortes, MD
• Matthew Kortes MD SC
• Kelly Michalski
• Ted Obermann, CSAC CS-IT
• Lanny Parker, CSAC
• Luke Timothy Pernsteiner, D.C.
• Lisa Petrack, PHARMD
• Raeann Wichlacz
• Trista Holly Raycher, MS

• Community/Retail Pharmacy in Abbotsford, WI
• Providers in Abbotsford, WI by specialty
• Community/Retail Pharmacy in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2009; 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.