Shopko Stores Operating Co LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

1001924 Issued in SD

Legal business name

SHOPKO STORES OPERATING CO LLC

Doing business as

Shopko Pharmacy 751

Practice address

1712 SD Highway 10
Sisseton, SD 57262-2523

Phone

(605) 698-3162

Fax

(605) 698-4340

NPI assigned

Mar 14, 2007

Last updated

Oct 5, 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 Presidend & Coo

Phone

(920) 429-4297

Specialties & licenses 3

Addresses

Other names 1

• Shopko Pharmacy 751 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

Locations

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349395200000",
    "number": "1972637072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1712 SD HIGHWAY 10",
            "city": "SISSETON",
            "state": "SD",
            "postal_code": "572622523",
            "telephone_number": "605-698-3162",
            "fax_number": "605-698-4340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1712 SD HIGHWAY 10",
            "city": "SISSETON",
            "state": "SD",
            "postal_code": "572622523",
            "telephone_number": "605-698-3162",
            "fax_number": "605-698-4340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO STORES OPERATING CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2012-10-05",
        "status": "A",
        "authorized_official_last_name": "BETTIGA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDEND & 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": "1001924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shopko Pharmacy 751",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Patricia Nicole Roth, LAC
• Leah Lorena Federico Rumans, CNP
• Ward Rumans
• Sanford Medical Center (Lewis Family Drug #44)
• Stephani Sue Scheurenbrand, CRNA
• Sisseton School District 54 2
• Sisseton Wahpeton Health Care Center
• Sisseton Wahpeton Oyate
• Sisseton Wahpeton Oyate Health Care Center
• Sisseton Wahpeton Oyate Healthcare Center (Woodrow Wilson Keeble Memorial Health Care Center)

• Community/Retail Pharmacy in Sisseton, SD
• Providers in Sisseton, 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 5, 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.