Shopko Stores Operating Co LLC
Organization Active NPI Community/Retail Pharmacy · Ainsworth, NE
NPI 1295921435 · NPPES record last updated Dec 31, 2012
Key facts
- NPI
- 1295921435
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- SHOPKO STORES OPERATING CO LLC
- Practice address
- 1511 East 4TH
Ainsworth, NE 69210 - Phone
- (402) 387-1533
- Fax
- (402) 387-1749
- NPI assigned
- Sep 21, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Michael Bettiga, RPH
- Title
- Executive Vice President and Coo
- Phone
- (920) 429-4297
National Provider Directory
Locations
1511 E 4th St
Ainsworth, NE 69210
Phone (402) 387-1533
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
1511 East 4TH
Ainsworth, NE 69210
Mailing address
1511 East 4TH
Ainsworth, NE 69210
Phone (402) 387-1533
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8535370 | Medicaid | SD | |
| 10025566200 | Medicaid | NE |
Other names
- Shopko Pharmacy 673
Other providers in Ainsworth, NE
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- Tylee Schroeder
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- Shannon Marie Sorensen
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All providers in Ainsworth, NE · Community/Retail Pharmacy in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 31, 2012. 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.