Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 112
Organization subpart
No
Provider details
NPI number
Authorized official
DILIP SEDANI (VP MANAGED HEALTH CARE)
(920) 429-7688
Entity
Organization
Contact information
Practice address
3101 N MONTANA AVE, HELENA, MT 59602
(406) 443-8823
(406) 443-2282
Mailing address
3101 N MONTANA AVE, HELENA, MT 59602-7813
(406) 443-8823
(406) 443-2282
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1197
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0213577
—
MT
05
—
0230435
—
MT
01
—
2705018
NCPDP NUMBER
—
05
—
5607331
—
MT
05
—
5607909
—
MT
Enumeration date
05/19/2006
Last updated
07/25/2018
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