Shopko Stores Operating Co LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

SHOPKO STORES OPERATING CO LLC

Practice address

1002 Old Minnesota Ave
Saint Peter, MN 56082-2023

Phone

(507) 931-4410

Fax

(507) 931-5434

NPI assigned

Jan 18, 2012

Organization subpart

No

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

Authorized official

Name

Michael Bettiga, RPH

Title

Executive Vice President and Coo

Phone

(920) 429-4297

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• SHOPKO PHARMACY 611 Doing business as

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

{
    "created_epoch": "1326844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384732800000",
    "number": "1073884458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1002 OLD MINNESOTA AVE",
            "city": "SAINT PETER",
            "state": "MN",
            "postal_code": "560822023",
            "telephone_number": "507-931-4410",
            "fax_number": "507-931-5434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 OLD MINNESOTA AVE",
            "city": "SAINT PETER",
            "state": "MN",
            "postal_code": "560822023",
            "telephone_number": "507-931-4410",
            "fax_number": "507-931-5434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-18",
        "last_updated": "2013-11-18",
        "status": "A",
        "authorized_official_last_name": "BETTIGA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT AND COO",
        "authorized_official_telephone_number": "920-429-4297",
        "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073884458",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SHOPKO PHARMACY 611",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Seeds of Serenity Mental Health PLLC
• Dana Jane Seifert, DPT
• Katherine Serrano
• Emily Rose Sheetz, LPCC
• Jordan Shoen, OTD, OTR/L
• William G Shores, MD
• Aubrey E Sieberg, PSYD, LP
• Kathy Sieveking, PSY.D., LP
• Diandra Elizabeth Sigurdsson, PSY.D.
• Christina Marie Simonette

• Community/Retail Pharmacy in Saint Peter, MN
• Providers in Saint Peter, 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 Nov 18, 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.