Shopko Stores Operating Co LLC
Organization Active NPI Community/Retail Pharmacy · Greenfield, IA
NPI 1720112816 · NPPES record last updated Apr 18, 2013
Key facts
- NPI
- 1720112816
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- SHOPKO STORES OPERATING CO LLC
- Practice address
- 202 SW Kent
Greenfield, IA 50849-0254 - Phone
- (641) 743-2201
- Fax
- (641) 743-2203
- NPI assigned
- Mar 14, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Michael Bettiga, RPH
- Title
- Executuive Vice President & Coo
- Phone
- (920) 429-4297
National Provider Directory
Locations
202 SW Kent St
Greenfield, IA 50849
Phone (641) 743-2201
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
202 SW Kent
Greenfield, IA 50849-0254
Mailing address
202 SW Kent
Greenfield, IA 50849-0254
Phone (641) 743-2201
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0766279 | Medicaid | IA |
Other names
- Shopko Pharmacy 687
Other providers in Greenfield, IA
- Joshua Amyas Rardin
- Lisa Anne Rardin
- Richard E Kohler DDS PC
- Ryan R. Frost, DDS, PLLC
- Spencer Sabourin
- Support Services of South Central Iowa
- Turning Point Counseling Services LLC
- Robert A Weiland
- Ashley Ann Williams
- Mary Jo Ytzen
All providers in Greenfield, IA · Community/Retail Pharmacy in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 18, 2013. 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.