Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 687
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BETTIGA RPH (EXECUTUIVE VICE PRESIDENT & COO)
(920) 429-4297
Entity
Organization
Contact information
Practice address
202 SW KENT, GREENFIELD, IA 50849-0254
(641) 743-2201
(641) 743-2203
Mailing address
202 SW KENT, GREENFIELD, IA 50849-0254
(641) 743-2201
(641) 743-2203
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
—
0766279
—
IA
Enumeration date
03/14/2007
Last updated
04/18/2013
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