# SHOPKO STORES OPERATING CO LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Shopko Pharmacy 615
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821042003
- **Authorized official:** MR. MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT & COO)
- **Authorized official phone:** (920) 429-4297

## Contact information

- **Practice address:** 291 S MAIN ST, CLINTONVILLE, WI 54929-1604
- **Practice address phone:** (715) 823-2350
- **Practice address fax:** (715) 823-2541
- **Mailing address:** 291 S MAIN ST, CLINTONVILLE, WI 54929-1604
- **Mailing address phone:** (715) 823-2350
- **Mailing address fax:** (715) 823-2541

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 05/20/2006
- **Last updated:** 09/24/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 33268600 | — | WI |
| 01 | — | 5127267 | NCPDP NUMBER | — |