Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 657
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
150 S 1ST ST, BLAIR, NE 68008-2540
(402) 426-9189
(402) 426-9190
Mailing address
PO BOX 1450, MINNEAPOLIS, MN 55485-5891
(402) 426-9189
(402) 426-9190
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
01
—
0459230047
MEDICARE ID - TYPE UNSPECIFIED
—
05
—
0721886
—
IA
05
—
0973404
—
IA
05
—
10025417400
—
NE
01
—
2814689
NCPDP
—
05
—
47062642603
—
NE
Enumeration date
05/19/2006
Last updated
08/28/2012
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us