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 764

Practice address

129 Harmony St
Buffalo, WY 82834-2463

Phone

(307) 684-4540

Fax

(307) 684-2220

NPI assigned

Oct 11, 2012

Last updated

Feb 12, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael Bettiga, RPH

Title

Executive Vice President and Coo

Phone

(920) 429-4297

Specialties & licenses 3

Addresses

Other names 1

• Shopko Pharmacy 764 Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Elizabeth Ketterling

  • Pharmacist
  • Buffalo, WY
  • NPI 1669772091
  NPD (past)
• Mandy Marie Schmidt, PHARMD

  • Pharmacist
  • Billings, MT
  • NPI 1316287105
  NPD (past)

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

{
    "created_epoch": "1349913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360627200000",
    "number": "1780936963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 HARMONY ST",
            "city": "BUFFALO",
            "state": "WY",
            "postal_code": "828342463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 HARMONY ST",
            "city": "BUFFALO",
            "state": "WY",
            "postal_code": "828342463",
            "telephone_number": "307-684-4540",
            "fax_number": "307-684-2220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-11",
        "last_updated": "2013-02-12",
        "status": "A",
        "authorized_official_last_name": "BETTIGA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT AND COO",
        "authorized_official_telephone_number": "920-429-4297",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shopko Pharmacy 764",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Thomas M Schnatterbeck, PSYD
• Mark Steven Schueler, MD
• Michael Scott Seeley
• Melissa Shafer, OTR/L
• Sherwood Group, Inc (Buffalo Physical Therapy)
• James Joseph Shubert, DMD
• Shannon Sickler
• Silver Lining LLC
• Mya Simondi
• Valerie Simondi

• Community/Retail Pharmacy in Buffalo, WY
• Providers in Buffalo, WY by specialty
• Community/Retail Pharmacy in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2013; 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.