NPIMap

Organization Active NPI

Shopko Stores Operating Co LLC

Doing business as Shopko Pharmacy 706

  • Durable Medical Equipment & Medical Supplies
  • Doniphan, MO
National Provider Identifier
1386825248
Registry record updated May 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
SHOPKO STORES OPERATING CO LLC
Doing business as
Shopko Pharmacy 706
Practice address
111 Leroux Dr
Doniphan, MO 63935
Phone
(573) 996-2311
Fax
(573) 996-7415
NPI assigned
Nov 20, 2007
Last updated
May 23, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
SHOPKO PHARMACY 706As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 23, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael Bettiga, RPH
Title
Excutive Vice President & Coo
Phone
(920) 429-4297

Specialties & licenses 3

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

Addresses

Primary practice location

111 Leroux Dr
Doniphan, MO 63935

Mailing address

111 Leroux Dr
Doniphan, MO 63935
Phone (573) 996-2311

Other names 1

  • Shopko Pharmacy 706 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Shopko Pharmacy 217916 organizations share this tax ID, including this one
Part of
Shopko Pharmacy 2179

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1195516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337731200000",
    "number": "1386825248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 LEROUX DR",
            "city": "DONIPHAN",
            "state": "MO",
            "postal_code": "63935",
            "telephone_number": "573-996-2311",
            "fax_number": "573-996-7415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 LEROUX DR",
            "city": "DONIPHAN",
            "state": "MO",
            "postal_code": "63935",
            "telephone_number": "573-996-2311",
            "fax_number": "573-996-7415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHOPKO PHARMACY 706",
        "enumeration_date": "2007-11-20",
        "last_updated": "2012-05-23",
        "status": "A",
        "authorized_official_last_name": "BETTIGA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "EXCUTIVE VICE PRESIDENT & COO",
        "authorized_official_telephone_number": "920-429-4297",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "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": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shopko Pharmacy 706",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Doniphan, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2012; 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.