Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 744
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
1087 3RD ST NW, ROSEAU, MN 56751-1902
(218) 463-2420
(218) 463-2421
Mailing address
1087 3RD ST NW, ROSEAU, MN 56751-1902
(218) 463-2420
(218) 463-2421
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
—
219311600
—
MN
01
—
2424961
NCPDP
—
05
—
606173000
—
MN
Enumeration date
05/20/2006
Last updated
10/09/2012
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