Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 707
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT & COO)
(920) 429-4297
Entity
Organization
Contact information
Practice address
101 S POLK ST, ALBANY, MO 64402-1617
(660) 726-3154
(660) 726-3167
Mailing address
101 S POLK ST, ALBANY, MO 64402-1617
(660) 726-3154
(660) 726-3167
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2635540
NCPDP
—
05
—
601586407
—
MO
05
—
621586403
—
MO
Enumeration date
06/03/2006
Last updated
02/18/2013
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