Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 109
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
4060 RIVERDALE RD, RIVERDALE, UT 84405-1518
(801) 392-6800
(801) 392-5389
Mailing address
4060 RIVERDALE RD, RIVERDALE, UT 84405-1518
(801) 392-6800
(801) 392-5389
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1327651703
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
410985054201
—
UT
01
—
4607353
NCPDP NUMBER
—
Enumeration date
05/13/2006
Last updated
08/14/2008
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up