Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 774
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT & COO)
(920) 429-4297
Entity
Organization
Contact information
Practice address
100 WASHINGTON ST, LIVINGSTON, MT 59047-4200
(406) 222-7082
(406) 222-7086
Mailing address
100 WASHINGTON ST, LIVINGSTON, MT 59047-4200
(406) 222-7082
(406) 222-7086
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
—
1821041641
—
MT
01
—
2704636
NCPDP
—
Enumeration date
05/19/2006
Last updated
11/20/2012
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