Shopko Stores Operating Co., LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

SHOPKO STORES OPERATING CO., LLC

Doing business as

Shopko Pharmacy #2681

Practice address

202 Susan Lawrence Drive
Ida Grove, IA 51445

Phone

(712) 364-3198

NPI assigned

Mar 31, 2016

Last updated

Jun 24, 2016By 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

Lorie Neumann

Title

Dir 3Rd Contract & Ca

Phone

(920) 429-4726

Specialties & licenses 3

Addresses

Other names 1

• Shopko Pharmacy #2681 Doing business as

Locations

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

{
    "created_epoch": "1459382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466726400000",
    "number": "1518320241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 SUSAN LAWRENCE DRIVE",
            "city": "IDA GROVE",
            "state": "IA",
            "postal_code": "51445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 SUSAN LAWRENCE DRIVE",
            "city": "IDA GROVE",
            "state": "IA",
            "postal_code": "51445",
            "telephone_number": "712-364-3198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-31",
        "last_updated": "2016-06-24",
        "status": "A",
        "authorized_official_last_name": "NEUMANN",
        "authorized_official_first_name": "LORIE",
        "authorized_official_title_or_position": "DIR 3RD CONTRACT & CA",
        "authorized_official_telephone_number": "920-429-4726"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shopko Pharmacy #2681",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Regional West Medical Center (Regional West Laboratory Services)
• Mallory Lynn Roling, ARNP
• Russell C. Spotts (Ida Grove Pharmacy)
• Sanford Clinic (Sanford Pulmonary Medicine Clinic)
• Sanford Health Network (Lewis Family Drug #55)
• Michelle Lynn Siebrecht, PA
• Sarah Tarr, RN
• Harvey J Tope, CRNA
• Debra Ann Ulrich, D.C.
• Sharon K Vande Vegte, DO

• Community/Retail Pharmacy in Ida Grove, IA
• Providers in Ida Grove, IA by specialty
• Community/Retail Pharmacy in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 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.