NPIMap

Organization Active NPI

Shopko Stores Operating Co LLC

Doing business as Shopko Pharmacy 677

  • Community/Retail Pharmacy
  • Onawa, IA
National Provider Identifier
1265485031
Registry record updated Jan 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
SHOPKO STORES OPERATING CO LLC
Doing business as
Shopko Pharmacy 677
Practice address
2220 Highway 175 W
Onawa, IA 51040-0149
Phone
(712) 423-9648
Fax
(712) 423-9659
NPI assigned
May 19, 2006
Last updated
Jan 25, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2013

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 and Coo
Phone
(920) 429-4297

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

2220 Highway 175 W
Onawa, IA 51040-0149

Mailing address

PO Box 149
Onawa, IA 51040-0149
Phone (712) 423-9648

Other identifiers 5

IdentifierTypeStateIssuer
10025417800MedicaidNE
1622249OtherNCPDP
0495572MedicaidIA
0456939MedicaidIA
10025240100MedicaidNE

Other names 1

  • Shopko Pharmacy 677 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": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359072000000",
    "number": "1265485031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 149",
            "city": "ONAWA",
            "state": "IA",
            "postal_code": "510400149",
            "telephone_number": "712-423-9648",
            "fax_number": "712-423-9659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2220 HIGHWAY 175 W",
            "city": "ONAWA",
            "state": "IA",
            "postal_code": "510400149",
            "telephone_number": "712-423-9648",
            "fax_number": "712-423-9659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2013-01-25",
        "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_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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025417800",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "1622249",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0495572",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0456939",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025240100",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shopko Pharmacy 677",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Onawa, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 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.