Shopko Stores Operating Co LLC
Organization Active NPI Community/Retail Pharmacy · Evart, MI
NPI 1740469394 · NPPES record last updated Feb 18, 2013
Key facts
- NPI
- 1740469394
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- SHOPKO STORES OPERATING CO LLC
- Practice address
- 107 North Main
Evart, MI 49631 - Phone
- (231) 734-5581
- Fax
- (231) 734-6170
- NPI assigned
- Oct 31, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Michael Bettiga, RPH
- Title
- Executive Vice President & Coo
- Phone
- (920) 429-4297
Member of 1
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
107 North Main
Evart, MI 49631
Mailing address
107 North Main
Evart, MI 49631
Phone (231) 734-5581
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2370459 | Medicaid | MI |
Other names
- Shopko Pharmacy 513
Other providers in Evart, MI
- Reed City Hospital Corporation
- Jessica Kim Roberts
- Rod E. Drouse D.C., P.C.
- Emily Elizabeth Rogers
- Laura Schuberg
- Springhill Camps
- Peter A Tomshack
- Michelle Vansickle
- Holly Jean Wolfe
- Sara Elizabeth Woolman
All providers in Evart, MI · Community/Retail Pharmacy in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 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.