Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 022
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
1900 N MAIN ST, MITCHELL, SD 57301-1160
(605) 996-6568
(605) 996-6627
Mailing address
1900 N MAIN ST, MITCHELL, SD 57301-1160
(605) 996-6568
(605) 996-6627
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1001905
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4300505
NCPDP NUMBER
—
05
—
8500490
—
SD
05
—
8500492
—
SD
05
—
9164970
—
SD
05
—
9164972
—
SD
Enumeration date
05/16/2006
Last updated
06/06/2014
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