Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 017
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
4161 2ND ST S, SAINT CLOUD, MN 56301-3761
(320) 253-3280
(320) 253-5790
Mailing address
4161 2ND ST S, SAINT CLOUD, MN 56301-3761
(320) 253-3280
(320) 253-5790
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2627960
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0154160058
—
MN
01
—
2414249
NCPDP NUMBER
—
05
—
578612000
—
MN
05
—
606234200
—
MN
05
—
625857300
—
MN
Enumeration date
05/19/2006
Last updated
05/22/2014
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us