Shopko Stores Operating Co LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

100-1902 Issued in SD

Legal business name

SHOPKO STORES OPERATING CO LLC

Doing business as

Shopko Pharmacy 746

Practice address

800 S Washington Ave
Madison, SD 57042-3520

Phone

(605) 256-6169

Fax

(605) 256-6461

NPI assigned

May 19, 2006

Last updated

Oct 1, 2012By 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

Mr. Michael Bettiga, RPH

Title

Executive Vice President & Coo

Phone

(920) 429-4297

Specialties & licenses 3

Addresses

Other names 1

• Shopko Pharmacy 746 Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Shopko Stores Operating Co LLC

  dba Shopko Pharmacy 2651

  • Community/Retail Pharmacy
  • Hart, MI
  • NPI 1699727511

  Member Of

  NPD member

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349049600000",
    "number": "1942253802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 S WASHINGTON AVE",
            "city": "MADISON",
            "state": "SD",
            "postal_code": "570423520",
            "telephone_number": "605-256-6169",
            "fax_number": "605-256-6461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 S WASHINGTON AVE",
            "city": "MADISON",
            "state": "SD",
            "postal_code": "570423520",
            "telephone_number": "605-256-6169",
            "fax_number": "605-256-6461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2012-10-01",
        "status": "A",
        "authorized_official_last_name": "BETTIGA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT & COO",
        "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": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "SD",
            "license": "100-1902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shopko Pharmacy 746",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Holly Katrina Sathoff, MSW, CSW
• Rachel Schardin
• Sidney Schoeberl, WHNP-BC
• Bernard Virgil Schuurmans, DDS
• Jodi B Schwan, BA
• Alexis P Siegmann, LMT
• Darrel L. Simon, CRNA
• Cara Sommerlot, ED.S.
• Emily Spanier, PA-C
• Janie Marie Stein, PTA

• Community/Retail Pharmacy in Madison, SD
• Providers in Madison, SD by specialty
• Community/Retail Pharmacy in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2012; 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.