Pamida Stores Operating Co LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

262795-7 Issued in MN

Legal business name

PAMIDA STORES OPERATING CO LLC

Doing business as

Pamida Pharmacy 317

Practice address

520 E Highway 12 Ste 110
Litchfield, MN 55355-2449

Phone

(320) 693-7034

Fax

(320) 693-7039

NPI assigned

May 20, 2006

Last updated

Nov 23, 2009By the provider in NPPES

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 3

Other names 1

• Pamida Pharmacy 317 Doing business as

Member of 1

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

• Shopko Stores Operating Co LLC

  dba Shopko Pharmacy 718

  • Community/Retail Pharmacy
  • Liberty, KY
  • NPI 1508819384

  Member Of

  NPD member

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael James Joldersma, RPH.

  • Pharmacist
  • Litchfield, MN
  • NPI 1104829647
  NPD (past)

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": "1487608600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 E HIGHWAY 12 STE 110",
            "city": "LITCHFIELD",
            "state": "MN",
            "postal_code": "553552449",
            "telephone_number": "320-693-7034",
            "fax_number": "320-693-7039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 E HIGHWAY 12 STE 110",
            "city": "LITCHFIELD",
            "state": "MN",
            "postal_code": "553552449",
            "telephone_number": "320-693-7034",
            "fax_number": "320-693-7039"
        }
    ],
    "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": "MN",
            "license": "262795-7",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "815761800",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2419035",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "768600000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pamida Pharmacy 317",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tasha L Nelson
• Steven Arthur Norman, PT
• Amy J Nyquist, O.D.
• Leif Olson, MD
• Sara Oster
• Anish Pathak, PHARMD, MBA
• Pathways Therapeutic Services, LLC
• Patten Chiropractic Center, PA
• Christopher Earl Patten, DC
• Debra Gay Peterson, MD

• Community/Retail Pharmacy in Litchfield, MN
• Providers in Litchfield, MN by specialty
• Community/Retail Pharmacy in Minnesota

• 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.