Shopko Stores Operating Co LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

262789-2 Issued in MN

Legal business name

SHOPKO STORES OPERATING CO LLC

Practice address

100 Evergreen SQ SW
Pine City, MN 55063-2000

Phone

(320) 629-3003

Fax

(320) 629-2987

NPI assigned

May 19, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Michael Bettiga, RPH

Title

Executive Vice President & Coo

Phone

(920) 429-4297

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Shopko Pharmacy 518 Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Pamida Stores Operating Co LLC

  • Community/Retail Pharmacy
  • California, MO
  • NPI 1336187707

  Member Of

  NPD member

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343692800000",
    "number": "1003869025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 EVERGREEN SQ SW",
            "city": "PINE CITY",
            "state": "MN",
            "postal_code": "550632000",
            "telephone_number": "320-629-3003",
            "fax_number": "320-629-2987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 EVERGREEN SQ SW",
            "city": "PINE CITY",
            "state": "MN",
            "postal_code": "550632000",
            "telephone_number": "320-629-3003",
            "fax_number": "320-629-2987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2012-07-31",
        "status": "A",
        "authorized_official_last_name": "BETTIGA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT & COO",
        "authorized_official_telephone_number": "920-429-4297",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MN",
            "license": "262789-2",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2418829",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shopko Pharmacy 518",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joan Marie Schroeder, LICSW
• Breanna Schwalbe
• Samantha Lee Schwieger
• Casey Jean Segarra, LPN
• Selah Wellness Clinic LLC
• Silver Linings Home Health Care LLC
• Gretchen Blaufuss Skalicky, D.C.
• Shelley Ann Skarda, B.S. LADC
• Cheryl K Smetana McHugh, LICSW
• Soliant Health

• Community/Retail Pharmacy in Pine City, MN
• Providers in Pine City, MN by specialty
• Community/Retail Pharmacy in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.