Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 108
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
955 N MAIN ST, SPANISH FORK, UT 84660-1150
(801) 798-3529
(801) 798-1182
Mailing address
955 N MAIN ST, SPANISH FORK, UT 84660-1150
(801) 798-3529
(801) 798-1182
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1327511703
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
410985054506
—
UT
01
—
4607341
NCPDP NUMBER
—
Enumeration date
05/13/2006
Last updated
06/06/2014
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