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Organization
SHOPKO STORES OPERATING CO LLC
Active
Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 049
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
500 N HIGHWAY 281, ABERDEEN, SD 57401-1821
(605) 225-3577
(605) 225-4170
Mailing address
500 N HIGHWAY 281, ABERDEEN, SD 57401-1821
(605) 225-3577
(605) 225-4170
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
332H00000X
Eyewear Supplier
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
1001906
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000020888SH
—
ND
05
—
21474
—
ND
01
—
4303777
NCPDP NUMBER
—
05
—
8502730
—
SD
05
—
8502732
—
SD
05
—
9166122
—
SD
05
—
9566280
—
SD
Enumeration date
05/16/2006
Last updated
10/28/2013
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