Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 122
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
1340 N WENATCHEE AVE, WENATCHEE, WA 98801-1558
(509) 664-5111
(509) 663-9006
Mailing address
1340 N WENATCHEE AVE, WENATCHEE, WA 98801-1558
(509) 664-5111
(509) 663-9006
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
3336C0003X
Community/Retail Pharmacy
Primary
CF00058639
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006013684
—
WA
01
—
0038601
WA LABOR & INDUSTRY
—
01
—
0215811
WA LABOR & INDUSTRY
—
01
—
4923389
NCPDP NUMBER
—
Enumeration date
06/07/2006
Last updated
06/06/2014
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