Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 692
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
1150 E 3RD ST, SUPERIOR, NE 68978-2026
(402) 879-4811
(402) 879-4812
Mailing address
PO BOX 6, SUPERIOR, NE 68978-0006
(402) 879-4811
(402) 879-4812
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
—
10024985900
—
NE
05
—
10025416000
—
NE
05
—
100459130A
—
KS
05
—
200389320E
—
KS
05
—
200389320F
—
KS
01
—
2816570
NCPDP
—
Enumeration date
05/19/2006
Last updated
02/12/2013
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