Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 740
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
116 E HIGHWAY 28, MORRIS, MN 56267-1171
(320) 589-0420
(320) 589-0416
Mailing address
116 E HIGHWAY 28, MORRIS, MN 56267-1171
(320) 589-0420
(320) 589-0416
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
01
—
2422501
NCPDP
—
05
—
302692000
—
MN
05
—
316721600
—
MN
Enumeration date
05/18/2006
Last updated
10/01/2012
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