Shopko Pharmacy 069

LBN: Shopko Stores Operating Co Llc
Shopko Pharmacy 069 is an health care organization with primary practice located at 217 W Ironwood Dr , Coeur D Alene ID 83814-2651. The organization recently has 4 registered licenses in different health care specialties including Suppliers / Durable Medical Equipment & Medical Supplies, Suppliers / Eyewear Supplier (Equipment, not the service), Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Shopko Stores Operating Co Llc can be contacted via phone (208) 765-9586, or through Steinhorst, Russell via phone (920) 429-7489.

Contact Information

Primary practice address
217 W Ironwood Dr Coeur D Alene ID 83814-2651
Phone: (208) 765-9586
Fax: (208) 765-6922
Website:
Map and Directions
Authorized official contact:
Name: Steinhorst, Russell
Phone: (920) 429-7489

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Durable Medical Equipment & Medical Supplies 332B00000X
Suppliers / Eyewear Supplier (Equipment, not the service) 332H00000X
Suppliers / Pharmacy 333600000X 2037CP Idaho
Suppliers / Community/Retail Pharmacy 3336C0003X 2037CP Idaho

Profile Details

NPI number 1164477881
LBN Legal business name Shopko Stores Operating Co Llc
DBA Doing business as Shopko Pharmacy 069
Authorized official Steinhorst, Russell
Entity Organization
Organization subpart 1 No
Enumeration date May 23rd, 2006
Last updated Dec 10th, 2015 - about 11 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164477881 NPPES
Other 1304613 NCPDP NUMBER
MEDICAID 000123200 NCPDP NUMBER
MEDICAID 000123100 NCPDP NUMBER
Other 0034347 NCPDP NUMBER
Other 0215806 NCPDP NUMBER

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