Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 164
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
255 JOHN F KENNEDY RD, DUBUQUE, IA 52002-5313
(563) 583-5808
(563) 583-5804
Mailing address
255 JOHN F KENNEDY RD, DUBUQUE, IA 52002-5313
(563) 583-5808
(563) 583-5804
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1070
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0181107
—
IA
05
—
0495309
—
IA
01
—
1619696
NCPDP NUMBER
—
05
—
33236500
—
WI
05
—
410985054164
—
IL
Enumeration date
05/15/2006
Last updated
08/14/2008
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