NPIMap

Organization Active NPI

Shopko Stores Operating Co. LLC

Doing business as ShopKo Pharmacy 094

  • Durable Medical Equipment & Medical Supplies
  • Eugene, OR
National Provider Identifier
1720030240
Registry record updated Sep 11, 2025
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 094
Practice address
955 Bailey Hill Rd
Eugene, OR 97402-5486
Phone
(541) 686-0849
Fax
(541) 687-7979
NPI assigned
May 16, 2006
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Mr. Michael J Bettiga, RPH
Title
Sr. Vice President Health Services
Phone
(920) 429-4297

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU Primary
Community/Retail Pharmacy 3336C0003X 1085 OR

Addresses

Primary practice location

955 Bailey Hill Rd
Eugene, OR 97402-5486

Mailing address

955 Bailey Hill Rd
Eugene, OR 97402-5486
Phone (541) 686-0849

Other identifiers 2

IdentifierTypeStateIssuer
002373MedicaidOR
3809968OtherNCPDP NUMBER

Other names 1

  • ShopKo Pharmacy 094 Doing business as

National Provider Directory

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

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": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1720030240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "955 BAILEY HILL RD",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974025486",
            "telephone_number": "541-686-0849",
            "fax_number": "541-687-7979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "955 BAILEY HILL RD",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974025486",
            "telephone_number": "541-686-0849",
            "fax_number": "541-687-7979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "BETTIGA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SR. VICE PRESIDENT HEALTH SERVICES",
        "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": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "OR",
            "license": "1085",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002373",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "3809968",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ShopKo Pharmacy 094",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eugene, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.