Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 751
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDEND & COO)
(920) 429-4297
Entity
Organization
Contact information
Practice address
1712 SD HIGHWAY 10, SISSETON, SD 57262-2523
(605) 698-3162
(605) 698-4340
Mailing address
1712 SD HIGHWAY 10, SISSETON, SD 57262-2523
(605) 698-3162
(605) 698-4340
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1001924
SD
Other
Enumeration date
03/14/2007
Last updated
10/05/2012
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