Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 757
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
1 N 5TH AVE, BELLE FOURCHE, SD 57717-1172
(605) 892-2252
(605) 892-4942
Mailing address
1 N 5TH AVE, BELLE FOURCHE, SD 57717-1172
(605) 892-2252
(605) 892-4942
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
—
118385100
—
WY
05
—
123293200
—
WY
05
—
123293201
—
WY
01
—
4304729
NCPDP
—
05
—
8502930
—
SD
05
—
8502932
—
SD
05
—
9167840
—
SD
Enumeration date
05/19/2006
Last updated
10/15/2012
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