NPIMap

Organization Active NPI

Shopko Stores Operating Co LLC

Doing business as Shopko Pharmacy 2651

  • Community/Retail Pharmacy
  • Hart, MI
National Provider Identifier
1699727511
Registry record updated Dec 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
SHOPKO STORES OPERATING CO LLC
Doing business as
Shopko Pharmacy 2651
Practice address
2278 N Comfort Dr
Hart, MI 49420-8155
Phone
(231) 873-1843
Fax
(231) 873-1774
NPI assigned
May 17, 2006
Last updated
Dec 14, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2015

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 Coo
Phone
(920) 429-7489

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

2278 N Comfort Dr
Hart, MI 49420-8155

Mailing address

2278 N Comfort Dr
Hart, MI 49420-8155
Phone (231) 873-1843

Other identifiers 4

IdentifierTypeStateIssuer
2361448OtherNCPDP NUMBER
4913884MedicaidMI
4819256MedicaidMI
2361448MedicaidMI

Other names 1

  • Shopko Pharmacy 2651 Doing business as

National Provider Directory

National Provider Directory

Member organizations 90

Organizations listed as members of this organization in the National Provider Directory.

View all 90

Locations

2278 N Comfort Dr
Hart, MI 49420
Phone (231) 873-1843

NPI Registry JSON

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450051200000",
    "number": "1699727511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2278 N COMFORT DR",
            "city": "HART",
            "state": "MI",
            "postal_code": "494208155",
            "telephone_number": "231-873-1843",
            "fax_number": "231-873-1774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2278 N COMFORT DR",
            "city": "HART",
            "state": "MI",
            "postal_code": "494208155",
            "telephone_number": "231-873-1843",
            "fax_number": "231-873-1774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2015-12-14",
        "status": "A",
        "authorized_official_last_name": "STEINHORST",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_title_or_position": "SVP AND COO",
        "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": "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": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "2361448",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4913884",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4819256",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2361448",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shopko Pharmacy 2651",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hart, MI

Sources for this page

  • 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.