NPIMap

Organization Active NPI

Shopko Stores Operating Co LLC

Doing business as ShopKo Pharmacy 015

  • Community/Retail Pharmacy
  • Appleton, WI
National Provider Identifier
1811943269
Registry record updated Jan 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
8592042 Issued in WI
Legal business name
SHOPKO STORES OPERATING CO LLC
Doing business as
ShopKo Pharmacy 015
Practice address
1000 W Northland Ave
Appleton, WI 54914-1419
Phone
(920) 739-6871
Fax
(920) 731-6167
NPI assigned
May 26, 2006
Last updated
Jan 21, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2014

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

Authorized official

Name
Mr. Michael J Bettiga, RPH
Title
Sr. Vice President Health Services
Phone
(920) 429-4297

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Eyewear Supplier 332H00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 8592042 WI Primary

Addresses

Primary practice location

1000 W Northland Ave
Appleton, WI 54914-1419

Mailing address

1000 W Northland Ave
Appleton, WI 54914-1419
Phone (920) 739-6871

Other names 1

  • ShopKo Pharmacy 015 Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390262400000",
    "number": "1811943269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 W NORTHLAND AVE",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549141419",
            "telephone_number": "920-739-6871",
            "fax_number": "920-731-6167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 W NORTHLAND AVE",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549141419",
            "telephone_number": "920-739-6871",
            "fax_number": "920-731-6167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2014-01-21",
        "status": "A",
        "authorized_official_last_name": "BETTIGA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SR. VICE PRESIDENT HEALTH SERVICES",
        "authorized_official_telephone_number": "920-429-4297",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "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": "8592042",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ShopKo Pharmacy 015",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Appleton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2014; 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.