Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 106
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
905 S 24TH ST W, BILLINGS, MT 59102-7408
(406) 652-6715
(406) 651-9380
Mailing address
905 S 24TH ST W, BILLINGS, MT 59102-7408
(406) 652-6715
(406) 651-9380
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1198
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0102720
—
WA
05
—
0230452
—
MT
05
—
0230607
—
MT
01
—
2704802
NCPDP NUMBER
—
05
—
5601557
—
MT
05
—
5607888
—
MT
Enumeration date
05/19/2006
Last updated
06/06/2014
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