Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 730
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
657 W MAIN ST, HODGENVILLE, KY 42748-1569
(270) 358-4391
(270) 358-4682
Mailing address
657 W MAIN ST, HODGENVILLE, KY 42748-1569
(270) 358-4391
(270) 358-4682
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
—
1825706
NCPDP NUMBER
—
05
—
5401320600
—
KY
05
—
5403488900
—
KY
Enumeration date
05/16/2006
Last updated
02/08/2013
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