Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 099
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
9366 STATE ROAD 16, ONALASKA, WI 54650-8526
(608) 781-5404
(608) 783-4966
Mailing address
9366 STATE ROAD 16, ONALASKA, WI 54650-8526
(608) 781-5404
(608) 783-4966
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8606042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
195560800
—
MN
05
—
33163900
—
WI
01
—
5119587
NCPDP
—
05
—
967190000
—
MN
Enumeration date
05/26/2006
Last updated
08/14/2008
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