Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 020
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
2400 ROSE ST, LA CROSSE, WI 54603-1612
(608) 781-3300
(608) 783-7810
Mailing address
2400 ROSE ST, LA CROSSE, WI 54603-1612
(608) 781-3300
(608) 783-7810
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8613042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33135500
—
WI
05
—
423358100
—
MN
01
—
5106516
NCPDP NUMBER
—
05
—
883693000
—
MN
Enumeration date
05/25/2006
Last updated
08/06/2008
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