Shopko Stores Operating Co LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

8603042 Issued in WI

Legal business name

SHOPKO STORES OPERATING CO LLC

Practice address

320 S Access Rd
Rice Lake, WI 54868-8572

Phone

(715) 236-7414

Fax

(715) 236-7714

NPI assigned

May 24, 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 Chief Financial Officer

Phone

(920) 429-7489

Specialties & licenses 4

Addresses

Other identifiers 2

Other names 1

• ShopKo Pharmacy 132 Doing business as

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497225600000",
    "number": "1780639906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 S ACCESS RD",
            "city": "RICE LAKE",
            "state": "WI",
            "postal_code": "548688572",
            "telephone_number": "715-236-7414",
            "fax_number": "715-236-7714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 S ACCESS RD",
            "city": "RICE LAKE",
            "state": "WI",
            "postal_code": "548688572",
            "telephone_number": "715-236-7414",
            "fax_number": "715-236-7714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2017-06-12",
        "status": "A",
        "authorized_official_last_name": "STEINHORST",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_title_or_position": "SVP CHIEF FINANCIAL OFFICER",
        "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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "8603042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "5122229",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33203200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ShopKo Pharmacy 132",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mildred Jean Seabold, MS, RD,CD
• Michael Seebruck, OD
• Lacey B. Seipp, COTA
• Irina Selezneva, MD
• Jared Richard Sherman, PA-C
• Shopko Stores Operating Co. LLC
• Shoptikal LLC
• Sikorski Hearing Aid Center, Inc.
• Samantha Elaine Sikorski, H.I.S
• Katherine L. Simeth, D.D.S.

• Community/Retail Pharmacy in Rice Lake, WI
• Providers in Rice Lake, 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 Jun 12, 2017; 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.