Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 078
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
1845 HAINES AVE, RAPID CITY, SD 57701-0663
(605) 342-1055
(605) 342-0677
Mailing address
1845 HAINES AVE, RAPID CITY, SD 57701-0663
(605) 342-1055
(605) 342-0677
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1001909
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4304022
NCPDP NUMBER
—
05
—
8503210
—
SD
05
—
8503212
—
SD
05
—
9161050
—
SD
05
—
9161052
—
SD
Enumeration date
05/16/2006
Last updated
10/22/2013
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