Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 746
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
800 S WASHINGTON AVE, MADISON, SD 57042-3520
(605) 256-6169
(605) 256-6461
Mailing address
800 S WASHINGTON AVE, MADISON, SD 57042-3520
(605) 256-6169
(605) 256-6461
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
100-1902
SD
Other
Enumeration date
05/19/2006
Last updated
10/01/2012
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