# SHOPKO STORES OPERATING CO LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Shopko Pharmacy 757
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871546820
- **Authorized official:** MR. MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT & COO)
- **Authorized official phone:** (920) 429-4297

## Contact information

- **Practice address:** 1 N 5TH AVE, BELLE FOURCHE, SD 57717-1172
- **Practice address phone:** (605) 892-2252
- **Practice address fax:** (605) 892-4942
- **Mailing address:** 1 N 5TH AVE, BELLE FOURCHE, SD 57717-1172
- **Mailing address phone:** (605) 892-2252
- **Mailing address fax:** (605) 892-4942

## 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:** 05/19/2006
- **Last updated:** 10/15/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 118385100 | — | WY |
| 05 | — | 123293200 | — | WY |
| 05 | — | 123293201 | — | WY |
| 01 | — | 4304729 | NCPDP | — |
| 05 | — | 8502930 | — | SD |
| 05 | — | 8502932 | — | SD |
| 05 | — | 9167840 | — | SD |