Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 057
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
405 COTTONWOOD DR, WINONA, MN 55987-1914
(507) 452-1244
(507) 457-3526
Mailing address
405 COTTONWOOD DR, WINONA, MN 55987-1914
(507) 452-1244
(507) 457-3526
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2628037
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
057482000
—
MN
01
—
2417865
NCPDP NUMBER
—
05
—
33070000
—
WI
05
—
676758300
—
MN
Enumeration date
05/19/2006
Last updated
08/07/2008
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