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Organization

SHOPKO STORES OPERATING CO LLC

Active
Other names
ShopKo Pharmacy 101
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
4501 E ARROWHEAD PKWY, SIOUX FALLS, SD 57110-2701
(605) 335-8806
(605) 335-0991
Mailing address
4501 E ARROWHEAD PKWY, SIOUX FALLS, SD 57110-2701
(605) 335-8806
(605) 335-0991

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
332H00000X
Eyewear Supplier
3336C0003X
Community/Retail Pharmacy
Primary
1001910
SD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
308498000
MN
01
4304161
NCPDP NUMBER
05
432018200
MN
05
8503500
SD
05
8503502
SD
05
9165130
SD
05
9165132
SD
Enumeration date
05/16/2006
Last updated
05/22/2014
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