Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 523
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
525 E HIGHWAY 20, VALENTINE, NE 69201-2115
(402) 376-3531
(402) 376-3560
Mailing address
525 E HIGHWAY 20, VALENTINE, NE 69201-2115
(402) 376-3531
(402) 376-3560
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10026193100
—
NE
Enumeration date
11/01/2007
Last updated
05/01/2014
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