Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 747
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
405 W INTERSTATE DR, LUVERNE, MN 56156-2266
(507) 283-2156
(507) 283-2168
Mailing address
405 W INTERSTATE DR, LUVERNE, MN 56156-2266
(507) 283-2156
(507) 283-2168
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
—
0545160
—
IA
05
—
0722538
—
IA
05
—
117475000
—
MN
01
—
2422258
NCPDP
—
05
—
546523100
—
MN
05
—
8530530
—
SD
05
—
8530532
—
SD
05
—
9167850
—
SD
Enumeration date
05/18/2006
Last updated
10/01/2012
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