Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 036
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
3708 HIGHWAY 63 N, ROCHESTER, MN 55906-3902
(507) 281-0658
(507) 281-4614
Mailing address
3708 HIGHWAY 63 N, ROCHESTER, MN 55906-3902
(507) 281-0658
(507) 281-4614
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2628011
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0177703
WLI
—
01
—
0215799
WLI
—
01
—
2415431
NCPDP NUMBER
—
05
—
306257100
—
MN
05
—
356447000
—
MN
Enumeration date
05/19/2006
Last updated
08/06/2008
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