Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 772
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
1005 W COULTER AVE, POWELL, WY 82435-2530
(307) 754-2755
(307) 754-7915
Mailing address
1005 W COULTER AVE, POWELL, WY 82435-2530
(307) 754-2755
(307) 754-7915
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
—
117709500
—
WY
05
—
123286000
—
WY
05
—
123286001
—
WY
01
—
5203776
NCPDP
—
Enumeration date
06/06/2006
Last updated
10/19/2012
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