Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 025
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
1200 SUSAN DR, MARSHALL, MN 56258-2580
(507) 537-9650
(507) 537-9646
Mailing address
1200 SUSAN DR, MARSHALL, MN 56258-2580
(507) 537-9650
(507) 537-9646
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2627999
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2421028
NCPDP NUMBER
—
05
—
318117000
—
MN
05
—
769015100
—
MN
Enumeration date
05/19/2006
Last updated
08/27/2013
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