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 684

Practice address

106 Smith St
Bloomfield, IA 52537-2140

Phone

(641) 664-2349

Fax

(641) 664-2464

NPI assigned

May 6, 2011

Last updated

Jan 18, 2013By the provider in NPPES

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 684 Doing business as

Locations

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

{
    "created_epoch": "1304640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358467200000",
    "number": "1225320419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 SMITH ST",
            "city": "BLOOMFIELD",
            "state": "IA",
            "postal_code": "525372140",
            "telephone_number": "641-664-2349",
            "fax_number": "641-664-2464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 SMITH ST",
            "city": "BLOOMFIELD",
            "state": "IA",
            "postal_code": "525372140",
            "telephone_number": "641-664-2349",
            "fax_number": "641-664-2464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-06",
        "last_updated": "2013-01-18",
        "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": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shopko Pharmacy 684",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jake Stephen Settles, D.O.
• Trina Marie Settles, DO
• William Brian Sharp, PT
• Monica Lynn Shelton, MS
• Silas Hyun Seok Shin, DO
• Lynette Sue Smith, R.D., L.D.
• Stephen Edward Sparks, MD
• Emily Kaye Speer, DC
• James L. Stogdill, D.C.
• Thomas G Juhl OD

• Community/Retail Pharmacy in Bloomfield, IA
• Providers in Bloomfield, IA by specialty
• Community/Retail Pharmacy in Iowa

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