Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 085
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
5800 S REDWOOD RD, SALT LAKE CITY, UT 84123-5327
(801) 967-5100
(801) 964-8201
Mailing address
5800 S REDWOOD RD, SALT LAKE CITY, UT 84123-5327
(801) 967-5100
(801) 964-8201
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1313471703
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
410985054040
—
UT
01
—
4606717
NCPDP NUMBER
—
Enumeration date
05/13/2006
Last updated
06/06/2014
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