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 662

Practice address

211 S 23Rd St
Plattsmouth, NE 68048-2903

Phone

(402) 296-6256

Fax

(402) 296-6262

NPI assigned

May 17, 2006

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 662 Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Pamida Stores Operating Co LLC

  dba Pamida Pharmacy 853

  • Community/Retail Pharmacy
  • California, MO
  • NPI 1336187707

  Member Of

  NPD member

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345680000000",
    "number": "1649222654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 S 23RD ST",
            "city": "PLATTSMOUTH",
            "state": "NE",
            "postal_code": "680482903",
            "telephone_number": "402-296-6256",
            "fax_number": "402-296-6262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 S 23RD ST",
            "city": "PLATTSMOUTH",
            "state": "NE",
            "postal_code": "680482903",
            "telephone_number": "402-296-6256",
            "fax_number": "402-296-6262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2012-08-23",
        "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": 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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shopko Pharmacy 662",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Charles Schram
• Teresa Schram
• Hunter Graham Severin
• James Edward Shade II
• Melissa Shade
• Shopko Stores Operating Co LLC (Shopko Optical)
• Tiffany Simon, RN
• Erin Gayle Smith, FNP-C
• Elisa Solis
• Aubry Reann Stark

• Community/Retail Pharmacy in Plattsmouth, NE
• Providers in Plattsmouth, NE by specialty
• Community/Retail Pharmacy in Nebraska

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