Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 677
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT AND COO)
(920) 429-4297
Entity
Organization
Contact information
Practice address
2220 HIGHWAY 175 W, ONAWA, IA 51040-0149
(712) 423-9648
(712) 423-9659
Mailing address
PO BOX 149, ONAWA, IA 51040-0149
(712) 423-9648
(712) 423-9659
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
—
0456939
—
IA
05
—
0495572
—
IA
05
—
10025240100
—
NE
05
—
10025417800
—
NE
01
—
1622249
NCPDP
—
Enumeration date
05/19/2006
Last updated
01/25/2013
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