Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 517
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
119 W SEMINARY ST, OWENTON, KY 40359
(502) 484-3444
(502) 484-5151
Mailing address
119 W SEMINARY ST, OWENTON, KY 40359
(502) 484-3444
(502) 484-5151
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
—
710027790
—
KY
Enumeration date
12/27/2007
Last updated
02/08/2013
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