NPIMap

Organization Active NPI

Shopko Stores Operating Co LLC

Doing business as ShopKo Pharmacy 044

  • Community/Retail Pharmacy
  • Omaha, NE
National Provider Identifier
1053362400
Registry record updated Aug 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
2678 Issued in NE
Legal business name
SHOPKO STORES OPERATING CO LLC
Doing business as
ShopKo Pharmacy 044
Practice address
3020 S 84TH St
Omaha, NE 68124-3215
Phone
(402) 391-6299
Fax
(402) 391-3335
NPI assigned
May 12, 2006
Last updated
Aug 27, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2013

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

Authorized official

Name
Mr. Michael J Bettiga, RPH
Title
Sr. Vice President Health Services
Phone
(920) 429-4297

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Eyewear Supplier 332H00000X
Community/Retail Pharmacy 3336C0003X 2678 NE Primary

Addresses

Primary practice location

3020 S 84TH St
Omaha, NE 68124-3215

Mailing address

3020 S 84TH St
Omaha, NE 68124-3215
Phone (402) 391-6299

Other identifiers 5

IdentifierTypeStateIssuer
2812205OtherNCPDP NUMBER
0721902MedicaidIA
41098505405MedicaidNE
0573824MedicaidIA
10025413800MedicaidNE

Other names 1

  • ShopKo Pharmacy 044 Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377561600000",
    "number": "1053362400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 S 84TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681243215",
            "telephone_number": "402-391-6299",
            "fax_number": "402-391-3335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3020 S 84TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681243215",
            "telephone_number": "402-391-6299",
            "fax_number": "402-391-3335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2013-08-27",
        "status": "A",
        "authorized_official_last_name": "BETTIGA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SR. VICE PRESIDENT HEALTH SERVICES",
        "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": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NE",
            "license": "2678",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "2812205",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0721902",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41098505405",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0573824",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025413800",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ShopKo Pharmacy 044",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Omaha, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2013; 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.