Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 714
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
202 MAIN ST, TARKIO, MO 64491-1541
(660) 736-4351
(660) 736-4385
Mailing address
202 MAIN ST, TARKIO, MO 64491-1541
(660) 736-4351
(660) 736-4385
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
—
2637518
NCPDP
MO
Enumeration date
08/01/2007
Last updated
08/28/2012
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