Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 098
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
2815 CHAD DR, EUGENE, OR 97408-7335
(541) 686-0094
(541) 338-9894
Mailing address
2815 CHAD DR, EUGENE, OR 97408-7335
(541) 686-0094
(541) 338-9894
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1086
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000690
—
OR
05
—
278348
—
OR
05
—
278379
—
OR
01
—
3809970
NCPDP NUMBER
—
Enumeration date
05/16/2006
Last updated
08/14/2008
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