Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 047
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
100 S 66TH ST, LINCOLN, NE 68510-2301
(402) 489-7148
(402) 489-6240
Mailing address
100 S 66TH ST, LINCOLN, NE 68510-2301
(402) 489-7148
(402) 489-6240
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2681
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025070800
—
NE
05
—
10025414100
—
NE
01
—
2812382
NCPDP NUMBER
—
Enumeration date
05/12/2006
Last updated
03/05/2014
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