Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 748
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
1002 7TH ST SE, PIPESTONE, MN 56164-2076
(507) 825-6517
(507) 825-6524
Mailing address
1002 7TH ST SE, PIPESTONE, MN 56164-2076
(507) 825-6517
(507) 825-6524
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
—
0585331
—
IA
05
—
0722520
—
IA
01
—
2422486
NCPDP
—
05
—
400992000
—
MN
05
—
545214700
—
MN
05
—
8533842
—
SD
Enumeration date
05/18/2006
Last updated
10/04/2012
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