Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 764
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT AND COO)
(920) 429-4297
Entity
Organization
Contact information
Practice address
129 HARMONY ST, BUFFALO, WY 82834-2463
(307) 684-4540
(307) 684-2220
Mailing address
129 HARMONY ST, BUFFALO, WY 82834-2463
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
10/11/2012
Last updated
02/12/2013
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