# 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 753
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972556926
- **Authorized official:** MR. MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT & COO)
- **Authorized official phone:** (920) 429-4297

## Contact information

- **Practice address:** 2701 HIGHWAY 18 W, HOT SPRINGS, SD 57747-6601
- **Practice address phone:** (605) 745-4681
- **Practice address fax:** (605) 745-4813
- **Mailing address:** 2701 HIGHWAY 18 W, HOT SPRINGS, SD 57747-6601
- **Mailing address phone:** (605) 745-4681
- **Mailing address fax:** (605) 745-4813

## 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:** 10/18/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 10025418100 | — | NE |
| 05 | — | 117793100 | — | WY |
| 05 | — | 123292400 | — | WY |
| 05 | — | 123292401 | — | WY |
| 01 | — | 4304630 | NCPDP | — |
| 05 | — | 47062642602 | — | NE |
| 05 | — | 8502040 | — | SD |
| 05 | — | 8502042 | — | SD |
| 05 | — | 9162102 | — | SD |
| 05 | — | 9566672 | — | SD |