Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 667
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
1501 PARK ST, SHELDON, IA 51201-1304
(712) 324-3552
(712) 324-2634
Mailing address
1501 PARK ST, SHELDON, IA 51201-1304
(712) 324-3552
(712) 324-2634
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
—
0102632
—
IA
05
—
0495648
—
IA
01
—
1617440
NCPDP
—
Enumeration date
05/18/2006
Last updated
10/19/2012
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