SHOPKO PHARMACY 004
NPI 1003862442
Pharmacy - Community/Retail Pharmacy in Green Bay, WI

Q: What is Shopko Stores Operating Co LLC's NPI number?

The NPI number for Shopko Stores Operating Co LLC is 1003862442. It was assigned to this organization in the NPPES registry on May 26, 2006. The provider is doing business as Shopko Pharmacy 004.

Q: What is Shopko Stores Operating Co LLC's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Active since May 26, 2006

2430 E MASON ST, GREEN BAY, WI 54302(920) 468-6044(920) 468-3490 Get Directions Write a Review

NPPES record last updated: February 14, 2014. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Shopko Pharmacy 004 NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHOPKO PHARMACY 004 (NPI 1003862442) is a healthcare organization registered as a community/retail pharmacy in Green Bay, Wisconsin and active in the NPI registry since May 2006. The organization lists Michael J Bettiga, Sr. Vice President Health Services, as its authorized official.

NPPES Registry Identity

NPI1003862442

Entity TypeOrganization

Primary Taxonomy3336C0003X

Legal Business NameSHOPKO STORES OPERATING CO LLC

Location Address2430 E MASON STGreen Bay, WI 54302-3759

Mailing Address2430 E Mason StGreen Bay, WI 54302-3759 · (920) 468-6044 · Fax (920) 468-3490

Phone(920) 468-6044

Fax(920) 468-3490

Organization SubpartNo

Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297

Enumeration DateMay 26, 2006

Last NPPES UpdateFebruary 14, 2014

✔ NPI 1003862442 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers

Taxonomy Code3336C0003X

License✔ Licensed in WI · 8636042

Definition

A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

Also ListedDurable Medical Equipment & Medical SuppliesTaxonomy 332B00000X

Also ListedEyewear SupplierTaxonomy 332H00000X

Also ListedPharmacyTaxonomy 333600000X

2430 E MASON ST, Green Bay, WI 54302

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Other Names 1

Doing Business AsShopko Pharmacy 004

Other Identifiers 4

Medicare NSC5695760097

Other5103926Ncpdp Number

Medicare ID-Type Unspecified0154160163

Medicaid33119300WI

Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LYNN MARIE BOND PHARMACIST

Pharmacist