Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 128
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
1370 US HIGHWAY 2 E, KALISPELL, MT 59901-3221
(406) 257-1274
(406) 257-1268
Mailing address
1370 US HIGHWAY 2 E, KALISPELL, MT 59901-3221
(406) 257-1274
(406) 257-1268
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1196
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0220844
—
MT
05
—
0230418
—
MT
01
—
2705424
NCPDP NUMBER
—
05
—
5604924
—
MT
05
—
5607901
—
MT
Enumeration date
05/19/2006
Last updated
01/21/2014
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