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Organization
SHOPKO STORES OPERATING CO LLC
Active
Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 093
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL J BETTIGA RPH (SR. VICE PRESIDENT HEALTH SERVICES)
(920) 429-4297
Entity
Organization
Contact information
Practice address
60 NE BEND RIVER MALL DR, BEND, OR 97701-7528
(541) 385-6076
(541) 385-9209
Mailing address
60 NE BEND RIVER MALL DR, BEND, OR 97701-7528
(541) 385-6076
(541) 385-9209
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
332H00000X
Eyewear Supplier
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
1084
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000682
—
OR
05
—
278350
—
OR
05
—
278377
—
OR
01
—
3809956
NCPDP NUMBER
—
Enumeration date
05/16/2006
Last updated
10/28/2013
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