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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