Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 035
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
2820 HIGHWAY 63 S, ROCHESTER, MN 55904-5571
(507) 281-0688
(507) 281-4612
Mailing address
2820 HIGHWAY 63 S, ROCHESTER, MN 55904-5571
(507) 281-0688
(507) 281-4612
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2628008
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
176257500
—
MN
01
—
2415429
NCPDP NUMBER
—
05
—
347223000
—
MN
05
—
798663000
—
MN
Enumeration date
05/19/2006
Last updated
04/23/2013
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