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 #2561

Practice address

145 Broadway Ave N
Cokato, MN 55321

Phone

(920) 429-4726

NPI assigned

Aug 7, 2015

Last updated

Dec 23, 2015By 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 3D Party Contract & Ca

Phone

(920) 429-4726

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Shopko Pharmacy #2561 Doing business as

Locations

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

{
    "created_epoch": "1438905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450828800000",
    "number": "1992181366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 BROADWAY AVENUE N",
            "city": "COKATO",
            "state": "MN",
            "postal_code": "55321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 BROADWAY AVE N",
            "city": "COKATO",
            "state": "MN",
            "postal_code": "55321",
            "telephone_number": "920-429-4726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-07",
        "last_updated": "2015-12-23",
        "status": "A",
        "authorized_official_last_name": "NEUMANN",
        "authorized_official_first_name": "LORIE",
        "authorized_official_title_or_position": "DIR 3D PARTY 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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992181366",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shopko Pharmacy #2561",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Minnesota Drug Acquisition Co LLC (Keaveny LTC Pharmacy #210)
• Nesseth Chiropractic Clinic PA
• David Gene Nesseth, DC
• Miriam V Ragab, DO
• Warren David Shepard, MD
• Simonson Hearing Services, Inc (Minnesota Hearing Solutions)
• Travis Simonson, H.I.S.
• Thomas Joseph Styrvoky, MD
• Marian Josephine Trautmann, MSE, LICSW
• Andrea Verhey, OTR

• Community/Retail Pharmacy in Cokato, MN
• Providers in Cokato, MN by specialty
• Community/Retail Pharmacy in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 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.