Organization
SHOPKO STORES OPERATING CO LLC
Active
Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 761
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
205 BOYD AVE, NEWCASTLE, WY 82701-2965
(307) 746-2741
(307) 746-9405
Mailing address
205 BOYD AVE, NEWCASTLE, WY 82701-2965
(307) 746-2741
(307) 746-9405
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
—
102724700
—
WY
05
—
123288600
—
WY
05
—
123288601
—
WY
01
—
5202572
NCPDP
—
05
—
8530192
—
SD
Enumeration date
06/06/2006
Last updated
11/02/2012
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