Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 518
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT & COO)
(920) 429-4297
Entity
Organization
Contact information
Practice address
100 EVERGREEN SQ SW, PINE CITY, MN 55063-2000
(320) 629-3003
(320) 629-2987
Mailing address
100 EVERGREEN SQ SW, PINE CITY, MN 55063-2000
(320) 629-3003
(320) 629-2987
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
262789-2
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2418829
NCPDP
—
Enumeration date
05/19/2006
Last updated
07/31/2012
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