Shopko Stores Operating Co LLC
Organization Active NPI Community/Retail Pharmacy · Hoopeston, IL
NPI 1669401899 · NPPES record last updated Aug 30, 2012
Key facts
- NPI
- 1669401899
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- SHOPKO STORES OPERATING CO LLC
- Practice address
- 1020 W Chestnut St
Hoopeston, IL 60942-1967 - Phone
- (217) 283-4456
- Fax
- (217) 283-4634
- NPI assigned
- Jul 1, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Michael Bettiga, RPH
- Title
- Executive Vice President & Coo
- Phone
- (920) 429-4297
National Provider Directory
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
1020 W Chestnut St
Hoopeston, IL 60942-1967
Mailing address
PO Box 1450
Minneapolis, MN 55485-5891
Phone (217) 283-4456
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0459230130 | Other | MEDICARE ID - TYPE UNSPECIFIED | |
| 1477341 | Other | NCPDP | |
| 470626426119 | Medicaid | IL | |
| 203606157004 | Medicaid | IL |
Other names
- Shopko Pharmacy 634
Other providers in Hoopeston, IL
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- Michael Dean Palmer
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- Megan Nicole Sandeno
- Christopher P. Scott
- Smart Chiropractic, LLC
- Jamee Sprague
- Charlotte D Strawser
- Sean Taheri
- Elizabeth Ann Totheroh
All providers in Hoopeston, 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 Aug 30, 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.