Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 769
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
1159 S CENTRAL AVE, SIDNEY, MT 59270-5219
(406) 482-6401
(406) 482-6402
Mailing address
1159 S CENTRAL AVE, SIDNEY, MT 59270-5219
(406) 482-6401
(406) 482-6402
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
05
—
1659325447
—
MT
01
—
2764113
NCPDP
—
Enumeration date
05/19/2006
Last updated
10/01/2012
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