Organization
SHOPKO STORES OPERATING CO LLC
Active
Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 134
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
1450 S GRAND AVE, PULLMAN, WA 99163-4900
(509) 332-0503
(509) 332-0233
Mailing address
1450 S GRAND AVE, PULLMAN, WA 99163-4900
(509) 332-0503
(509) 332-0233
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
3336C0003X
Community/Retail Pharmacy
Primary
CF00058645
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006018527
—
WA
01
—
0107798
WA LABOR & INDUSTRY
—
01
—
0215812
WA LABOR & INDUSTRY
—
01
—
4925179
NCPDP NUMBER
—
Enumeration date
06/05/2006
Last updated
06/06/2014
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