Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 735
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
190 SOUTHGATE DR, AITKIN, MN 56431-7407
(218) 927-2466
(218) 927-2597
Mailing address
190 SOUTHGATE DR, AITKIN, MN 56431-7407
(218) 927-2466
(218) 927-2597
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
262790-2
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209860100
—
MN
01
—
2420482
NDPDP
—
05
—
777133000
—
MN
Enumeration date
05/19/2006
Last updated
10/05/2012
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