Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 733
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT & COO)
(402) 596-7206
Entity
Organization
Contact information
Practice address
226 E LINCOLN AVE, FERGUS FALLS, MN 56537-2237
(218) 736-7531
(218) 736-7532
Mailing address
226 E LINCOLN AVE, FERGUS FALLS, MN 56537-2237
(218) 736-7531
(218) 736-7532
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
01
—
2420228
NCPDP
—
05
—
288860200
—
MN
05
—
912475000
—
MN
Enumeration date
05/18/2006
Last updated
09/24/2012
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