Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 706
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BETTIGA (EXECUTIVE VICE PRESIDENT & COO)
(920) 429-4297
Entity
Organization
Contact information
Practice address
115 LEROUX ST, DONIPHAN, MO 63935-1038
(573) 996-2311
(573) 996-7415
Mailing address
115 LEROUX ST, DONIPHAN, MO 63935-1038
(573) 996-2311
(573) 996-7415
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
10/12/2007
Last updated
07/31/2012
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