Organization
SHOPKO STORES OPERATING CO., LLC
Active
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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