Shopko Stores Operating Co LLC
Organization Active NPI Community/Retail Pharmacy · Hodgenville, KY
NPI 1114979531 · NPPES record last updated Feb 8, 2013
Key facts
- NPI
- 1114979531
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- SHOPKO STORES OPERATING CO LLC
- Practice address
- 657 W Main St
Hodgenville, KY 42748-1569 - Phone
- (270) 358-4391
- Fax
- (270) 358-4682
- NPI assigned
- May 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Michael Bettiga, RPH
- Title
- Executive Vice President & Coo
- Phone
- (920) 429-4297
National Provider Directory
Locations
657 W Main St
Hodgenville, KY 42748
Phone (270) 358-4391
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
657 W Main St
Hodgenville, KY 42748-1569
Mailing address
657 W Main St
Hodgenville, KY 42748-1569
Phone (270) 358-4391
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5401320600 | Medicaid | KY | |
| 1825706 | Other | NCPDP NUMBER | |
| 5403488900 | Medicaid | KY |
Other names
- Shopko Pharmacy 730
Other providers in Hodgenville, KY
- Kayla Shae Pullin
- Bobbe Gaye Renshaw
- Celeste Seadler
- Alexa Nicole Sheffield
- Doddachallor Matt Shivakumar
- Smith Drug Co, Inc
- Rebecca Grace Smith
- Melanie Lynn Staderman
- Steven Preston MD PLLC
- Li Tan
All providers in Hodgenville, KY · Community/Retail Pharmacy in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 8, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.