Shopko Pharmacy 2123
LBN: Shopko Stores Operating Co Llc
Shopko Pharmacy 2123 is an health care organization with primary practice located at 900 Memorial Rd , Houghton MI 49931-2481. The organization recently has 3 registered licenses in different health care specialties including Suppliers / Durable Medical Equipment & Medical Supplies, Suppliers / Eyewear Supplier (Equipment, not the service), Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty.
Shopko Stores Operating Co Llc can be contacted via phone (906) 487-9797, or through Steinhorst, Russell via phone (920) 429-7489.
Contact Information
Primary practice address
900 Memorial Rd
Houghton MI 49931-2481
Phone: (906) 487-9797
Fax: (906) 487-9380
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Durable Medical Equipment & Medical Supplies | 332B00000X | ||
| Suppliers / Eyewear Supplier (Equipment, not the service) | 332H00000X | ||
| Suppliers / Community/Retail Pharmacy | 3336C0003X | 5301008362 | Michigan |
Profile Details
| NPI number | 1932150372 |
|---|---|
| LBN Legal business name | Shopko Stores Operating Co Llc |
| DBA Doing business as | Shopko Pharmacy 2123 |
| Authorized official | Steinhorst, Russell |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | May 12th, 2006 |
| Last updated | Aug 3rd, 2016 - about 8 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1932150372 | NPPES |
| Other | 4819013 | MI MEDICAID DME | |
| MEDICAID | 2352451 | MI MEDICAID DME | |
| Other | 2352451 | MI MEDICAID DME | |
| Other | 9000C110300 | MI MEDICAID DME | |
| Other | 4913392 | MI MEDICAID DME |
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