Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 683
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
109 N MARKET ST, AUDUBON, IA 50025-1173
(712) 563-3302
(712) 563-3404
Mailing address
109 N MARKET ST, AUDUBON, IA 50025-1173
(712) 563-3302
(712) 563-3404
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
—
0433367
—
IA
05
—
0495895
—
IA
01
—
1621920
NCPDP
—
Enumeration date
05/16/2006
Last updated
01/14/2013
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