Shopko Stores Operating Co LLC
Organization Active NPI Community/Retail Pharmacy · Glenwood, MN
NPI 1982657045 · NPPES record last updated Apr 30, 2018
Key facts
- NPI
- 1982657045
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- SHOPKO STORES OPERATING CO LLC
- Practice address
- 710 County Road 21 S
Glenwood, MN 56334-9145 - Phone
- (320) 634-4399
- Fax
- (320) 634-4425
- NPI assigned
- May 18, 2006
- Organization subpart
- No
Authorized official
- Name
- Jannie Delane Paschal
- Title
- VP
- Phone
- (920) 429-4726
Member of 1
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
710 County Road 21 S
Glenwood, MN 56334-9145
Mailing address
710 County Road 21 S
Glenwood, MN 56334-9145
Phone (320) 634-4399
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 802967900 | Medicaid | MN | |
| 911938000 | Medicaid | MN | |
| 2423452 | Other | NCPDP |
Other names
- Shopko Pharmacy 739
Other providers in Glenwood, MN
- Rebekah Ruth Rick
- Scott William Ringdahl
- Melissa A Saari
- Jeffrey Alan Schlueter
- Joseph Anthony Schneiderhan
- Kimberly Spivack
- Rebeka A Srbu
- The Evangelical Lutheran Good Samaritan Society
- Joshua David Thomas
- Jodie Louise Trill
All providers in Glenwood, MN · Community/Retail Pharmacy in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 30, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.