Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 750
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
2155 1ST AVE N, WINDOM, MN 56101-1286
(507) 831-0263
(507) 831-0263
Mailing address
2155 1ST AVE N, WINDOM, MN 56101-1286
(507) 831-0263
(507) 831-0263
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
—
142427000
—
MN
01
—
2421131
NCPDP
—
05
—
363213000
—
MN
Enumeration date
05/18/2006
Last updated
09/24/2012
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