Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 753
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
2701 HIGHWAY 18 W, HOT SPRINGS, SD 57747-6601
(605) 745-4681
(605) 745-4813
Mailing address
2701 HIGHWAY 18 W, HOT SPRINGS, SD 57747-6601
(605) 745-4681
(605) 745-4813
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
—
10025418100
—
NE
05
—
117793100
—
WY
05
—
123292400
—
WY
05
—
123292401
—
WY
01
—
4304630
NCPDP
—
05
—
47062642602
—
NE
05
—
8502040
—
SD
05
—
8502042
—
SD
05
—
9162102
—
SD
05
—
9566672
—
SD
Enumeration date
05/19/2006
Last updated
10/18/2012
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