Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 092
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
867 N COLUMBIA CENTER BLVD, KENNEWICK, WA 99336-7771
(509) 736-0505
(509) 783-0214
Mailing address
867 N COLUMBIA CENTER BLVD, KENNEWICK, WA 99336-7771
(509) 736-0505
(509) 783-0214
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
3336C0003X
Community/Retail Pharmacy
Primary
CF00058647
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006130025
—
WA
01
—
0056488
WA LABOR & INDUSTRY
—
01
—
0215809
WA LABOR & INDUSTRY
—
01
—
4919683
NCPDP NUMBER
—
Enumeration date
06/07/2006
Last updated
06/06/2014
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