Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 175
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
6845 S 27TH ST, LINCOLN, NE 68512-4823
(402) 420-1199
(402) 420-2926
Mailing address
6845 S 27TH ST, LINCOLN, NE 68512-4823
(402) 420-1199
(402) 420-2926
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2708
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025414600
—
NE
01
—
2815871
NCPDP NUMBER
—
05
—
41098505456
—
NE
Enumeration date
05/12/2006
Last updated
06/06/2014
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