Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 722
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
4869 STATE ROUTE 125, GEORGETOWN, OH 45121-9550
(937) 378-6849
(937) 378-2679
Mailing address
4869 STATE ROUTE 125, GEORGETOWN, OH 45121-9550
(937) 378-6849
(937) 378-2679
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
—
0991495
—
OH
01
—
3659743
NCPDP NUMBER
—
Enumeration date
05/17/2006
Last updated
03/05/2013
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