Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 054
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
700 9TH AVE SE, WATERTOWN, SD 57201-5222
(605) 882-2011
(605) 886-6715
Mailing address
700 9TH AVE SE, WATERTOWN, SD 57201-5222
(605) 882-2011
(605) 886-6715
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1001907
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
260433000
—
MN
01
—
4303880
NCPDP NUMBER
—
05
—
8502830
—
SD
05
—
8502832
—
SD
05
—
9165520
—
SD
05
—
9165522
—
SD
05
—
979757200
—
MN
Enumeration date
05/15/2006
Last updated
06/06/2014
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