Organization
SHOPKO STORES OPERATING CO LLC
Active
Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 045
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
601 GALVIN RD S, BELLEVUE, NE 68005-2249
(402) 293-1845
(402) 293-0385
Mailing address
601 GALVIN RD S, BELLEVUE, NE 68005-2249
(402) 293-1845
(402) 293-0385
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2679
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025074100
—
NE
05
—
10025413900
—
NE
01
—
2812368
NCPDP NUMBER
—
Enumeration date
05/12/2006
Last updated
03/13/2014
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