Shopko Stores Operating Co LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

SHOPKO STORES OPERATING CO LLC

Doing business as

Shopko Pharmacy 732

Practice address

3225 10TH St E
Glencoe, MN 55336-3369

Phone

(320) 864-5026

Fax

(320) 864-5194

NPI assigned

May 20, 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 names 1

• Shopko Pharmacy 732 Doing business as

Member of 1

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

• Shopko Stores Operating Co LLC

  dba Shopko Pharmacy 526

  • Community/Retail Pharmacy
  • Afton, WY
  • NPI 1891971719

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345680000000",
    "number": "1073567558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3225 10TH ST E",
            "city": "GLENCOE",
            "state": "MN",
            "postal_code": "553363369",
            "telephone_number": "320-864-5026",
            "fax_number": "320-864-5194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3225 10TH ST E",
            "city": "GLENCOE",
            "state": "MN",
            "postal_code": "553363369",
            "telephone_number": "320-864-5026",
            "fax_number": "320-864-5194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-20",
        "last_updated": "2012-08-23",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shopko Pharmacy 732",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nina Suzann Schmidt
• Michele Schuberg
• Rachel Marie Senske
• Linda Senst, BA
• Marty Sherman, LADC
• Shopko Stores Operating Co LLC (Shopko Optical)
• Robin Sikkila, PHN
• Kenneth M Smith, MD
• Peter Thomas Smyth, MD
• Laurie Ann Snegosky, RN/PHN

• Community/Retail Pharmacy in Glencoe, MN
• Providers in Glencoe, 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 Aug 23, 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.