Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 169
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL J BETTIGA RPH (SR. VICE PRESIDENT HEALTH SERVICES)
(920) 429-4297
Entity
Organization
Contact information
Practice address
3499 E FAIRVIEW AVE, MERIDIAN, ID 83642-5848
(208) 884-1286
(208) 884-1186
Mailing address
3499 E FAIRVIEW AVE, MERIDIAN, ID 83642-5848
(208) 884-1286
(208) 884-1186
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
2038CP
ID
3336C0003X
Community/Retail Pharmacy
Primary
2038CP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1306807
NCPDP NUMBER
—
05
—
805516800
—
ID
Enumeration date
06/01/2006
Last updated
07/10/2009
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us