Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 053
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
510 E PHILIP AVE, NORTH PLATTE, NE 69101-5538
(308) 534-7353
(308) 534-2625
Mailing address
510 E PHILIP AVE, NORTH PLATTE, NE 69101-5538
(308) 534-7353
(308) 534-2625
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2682
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025414300
—
NE
01
—
2812748
NCPDP NUMBER
—
05
—
41098505415
—
NE
Enumeration date
05/13/2006
Last updated
10/28/2013
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