Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 076
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
1601 W 41ST ST, SIOUX FALLS, SD 57105-6371
(605) 338-3155
(605) 334-4915
Mailing address
1601 W 41ST ST, SIOUX FALLS, SD 57105-6371
(605) 338-3155
(605) 334-4915
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1001908
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0722660
—
IA
05
—
0966796
—
IA
05
—
191318200
—
MN
01
—
4304008
NCPDP NUMBER
—
05
—
8503110
—
SD
05
—
8503112
—
SD
05
—
886682000
—
MN
05
—
9164950
—
SD
05
—
9164952
—
SD
Enumeration date
05/15/2006
Last updated
06/06/2014
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