Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 524
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
114 S MAIN, SMTIH CENTER, KS 66967
(785) 282-6443
(785) 282-3550
Mailing address
PO BOX 1450, NW 5891, MINNEAPOLIS, MN 55485-5891
(785) 282-6443
(785) 282-3550
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
05
—
200389320I
—
KS
Enumeration date
10/31/2007
Last updated
02/11/2013
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