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Organization

SHOPKO STORES OPERATING CO LLC

Active
Other names
ShopKo Pharmacy 605
Organization subpart
No

Provider details

NPI number
Authorized official
MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT AND COO)
(920) 429-4297
Entity
Organization

Contact information

Practice address
340 HIGHWAY 65 S, MORA, MN 55051-1619
(320) 679-5950
(320) 679-5956
Mailing address
340 HIGHWAY 65 S, MORA, MN 55051-1619
(320) 679-5950
(320) 679-5956

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
333600000X
Pharmacy
3336C0003X
Community/Retail Pharmacy
Primary
263662
MN

Other

Enumeration date
03/17/2011
Last updated
03/17/2011
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