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Organization
SHOPKO STORES OPERATING CO LLC
Active
Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 759
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT AND COO)
(920) 429-4297
Entity
Organization
Contact information
Practice address
2105 LAZELLE ST, STE 2, STURGIS, SD 57785-3028
(605) 347-4553
(605) 347-4947
Mailing address
2105 LAZELLE ST, STE 2, STURGIS, SD 57785-3028
(605) 347-4553
(605) 347-4947
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4305137
NCPDP
—
05
—
8503842
—
SD
05
—
8503843
—
SD
05
—
9165603
—
SD
05
—
9566700
—
SD
05
—
9566702
—
SD
05
—
9580690
—
SD
Enumeration date
05/19/2006
Last updated
12/18/2012
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