Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 776
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
925 N 6TH STREET, GREYBULL, WY 82426
(307) 765-4601
(307) 765-4600
Mailing address
925 N 6TH ST, GREYBULL, WY 82426
(307) 765-4601
(307) 765-4600
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
—
125144900
—
WY
Enumeration date
09/19/2007
Last updated
10/15/2012
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