Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 745
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
1140 E 5TH ST, WINNER, SD 57580-2149
(605) 842-3242
(605) 842-0372
Mailing address
1140 E 5TH ST, WINNER, SD 57580-2149
(605) 842-3242
(605) 842-0372
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
100-1904
SD
Other
Enumeration date
05/19/2006
Last updated
09/19/2012
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