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Organization

SHOPKO STORES OPERATING CO LLC

Active
Other names
SHOPKO PHARMACY 794
Organization subpart
No

Provider details

NPI number
Authorized official
MICHAEL BETTIGA RPH (EXECUTIVE VP & COO)
(920) 429-4297
Entity
Organization

Contact information

Practice address
101 F ST SW, QUINCY, WA 98848-1213
(509) 787-4437
(509) 787-5012
Mailing address
101 F ST SW, QUINCY, WA 98848-1213

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
01
CF60451750
STATE LICENSE
WA
Enumeration date
02/27/2014
Last updated
03/07/2023
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