Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 066
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
9520 N NEWPORT HWY, SPOKANE, WA 99218-1219
(509) 466-7414
(509) 466-0546
Mailing address
9520 N NEWPORT HWY, SPOKANE, WA 99218-1219
(509) 466-7414
(509) 466-0546
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
3336C0003X
Community/Retail Pharmacy
Primary
CF00058644
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006004071
—
WA
01
—
0013174
WA LABOR & INDUSTRY
—
01
—
0215797
WA LABOR & INDUSTRY
—
01
—
4918275
NCPDP NUMBER
—
Enumeration date
06/05/2006
Last updated
08/28/2015
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