Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 096
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
55 LAKE BLVD, REDDING, CA 96003-2500
(530) 241-0713
(530) 241-1447
Mailing address
55 LAKE BLVD, REDDING, CA 96003-2500
(530) 241-0713
(530) 241-1447
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY47484
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0598194
NCPDP NUMBER
—
05
—
1ZXPHA358300
—
CA
05
—
MFGPHA376480
—
CA
05
—
PHA376480
—
CA
05
—
PHA474840
—
CA
05
—
QN4PHA474840
—
CA
Enumeration date
06/18/2006
Last updated
08/14/2008
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