Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 021
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
1850 E MADISON AVE, MANKATO, MN 56001-5448
(507) 387-6515
(507) 387-1680
Mailing address
1850 E MADISON AVE, MANKATO, MN 56001-5448
(507) 387-6515
(507) 387-1680
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2627973
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
077472000
—
MN
05
—
234058500
—
MN
01
—
2417144
NCPDP NUMBER
—
05
—
808787300
—
MN
Enumeration date
05/19/2006
Last updated
03/13/2014
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