Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 661
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
500 PLAZA DRIVE, WEST POINT, NE 68788-1835
(402) 372-5655
(402) 372-4966
Mailing address
PO BOX 1450, MINNEAPOLIS, MN 55485-5891
(402) 372-5655
(402) 372-4966
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
—
0459230137
MEDICARE ID - TYPE UNSPECIFIED
—
05
—
10025232900
—
NE
05
—
10025416600
—
NE
01
—
2817015
NCPDP
—
Enumeration date
05/19/2006
Last updated
08/21/2012
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