Organization
SHOPKO STORES OPERATING CO., LLC
Active
Other names
Shopko Pharmacy 669
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT & COO)
(920) 429-4297
Entity
Organization
Contact information
Practice address
1345 S FREDERICK AVE, OELWEIN, IA 50662-3060
(319) 283-2028
(319) 283-6653
Mailing address
1345 S FREDERICK AVE, OELWEIN, IA 50662-3060
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
IA
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
07/29/2010
Last updated
10/25/2012
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