Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 023
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
125 MAIN ST N, HUTCHINSON, MN 55350-1807
(320) 587-4941
(320) 587-4962
Mailing address
125 MAIN ST N, HUTCHINSON, MN 55350-1807
(320) 587-4941
(320) 587-4962
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2627986
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2420355
NCPDP NUMBER
—
05
—
337487400
—
MN
05
—
407647000
—
MN
05
—
479060000
—
MN
Enumeration date
05/19/2006
Last updated
11/06/2013
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