Shopko Stores Operating Co LLC
Organization Active NPI Community/Retail Pharmacy · Tuscola, IL
NPI 1316976558 · NPPES record last updated Sep 7, 2012
Key facts
- NPI
- 1316976558
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- SHOPKO STORES OPERATING CO LLC
- Practice address
- 700 Progress Blvd
Tuscola, IL 61953-2070 - Phone
- (217) 253-5123
- Fax
- (217) 253-5124
- NPI assigned
- Jul 1, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Michael Bettiga, RPH
- Title
- Executive Vice President & Coo
- Phone
- (920) 429-4297
Member of 1
National Provider Directory
Locations
1012 Apgar Ave
Tuscola, IL 61953
Phone (217) 253-5123
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
700 Progress Blvd
Tuscola, IL 61953-2070
Mailing address
700 Progress Blvd
Tuscola, IL 61953-2070
Phone (217) 253-5123
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0459230088 | Other | MEDICARE ID - TYPE UNSPECIFIED |
Other names
- Shopko Pharmacy 640
Other providers in Tuscola, IL
- Prairie Circle Dental, P.C.
- Alison S Ray
- Nathan L Roberts
- George Rotramel
- Sally J Salmons
- Shanti Priya Subbarao
- Bart M Tate
- Douglas Alan Teel
- Payton Turk
- Tuscola Comm Unit School Dist 301
All providers in Tuscola, IL · Community/Retail Pharmacy in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 7, 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.