Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 081
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
5801 SUMMITVIEW AVE, YAKIMA, WA 98908-3006
(509) 965-6393
(509) 965-5966
Mailing address
5801 SUMMITVIEW AVE, YAKIMA, WA 98908-3006
(509) 965-6393
(509) 965-5966
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
CF00058641
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006016455
—
WA
01
—
0006499
WA LABOR & INDUSTRY
—
01
—
0215796
WA LABOR & INDUSTRY
—
01
—
4919203
NCPDP NUMBER
—
Enumeration date
06/07/2006
Last updated
08/14/2008
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