SHOPKO PHARMACY 058
NPI 1063466852
Pharmacy - Community/Retail Pharmacy in Worthington, MN

Active since May 19, 2006
1755 N HUMISTON AVE, WORTHINGTON, MN 56187(507) 376-9309(507) 372-7840 Get Directions Write a Review

NPPES record last updated: January 21, 2014. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Shopko Pharmacy 058 NPPES

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

SHOPKO PHARMACY 058 (NPI 1063466852) is a healthcare organization registered as a community/retail pharmacy in Worthington, Minnesota 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

NPI1063466852
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameSHOPKO STORES OPERATING CO LLC
Location Address1755 N HUMISTON AVEWorthington, MN 56187-1757
Mailing Address1755 N Humiston AveWorthington, MN 56187-1757 · (507) 376-9309 · Fax (507) 372-7840
Fax(507) 372-7840
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 19, 2006
Last NPPES UpdateJanuary 21, 2014
NPI 1063466852 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
License Licensed in MN · 2628040
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
1755 N HUMISTON AVE, Worthington, MN 56187

Other Names 1

Doing Business AsShopko Pharmacy 058

Other Identifiers 8

Medicare ID-Type Unspecified1111590008
Medicaid166523500MN
Medicaid0722512IA
Medicaid0509463IA
Medicaid788690100MN
Medicare NSC5695760032
Other2416801Ncpdp Number
Medicaid060258200MN

Other Providers at the Same Location NPPES 5

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

Pharmacist
1755 N HUMISTON AVE
WORTHINGTON, MN 56187
Optometrist
1755 N HUMISTON AVE
WORTHINGTON, MN 56187
Pharmacist
1755 N HUMISTON AVE
WORTHINGTON, MN 56187
Pharmacist
1755 N HUMISTON AVE
WORTHINGTON, MN 56187
Eyewear Supplier
1755 N HUMISTON AVE
WORTHINGTON, MN 56187

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

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

The NPI number for Shopko Stores Operating Co LLC is 1063466852. It was assigned to this organization in the NPPES registry on May 19, 2006. The provider is doing business as Shopko Pharmacy 058.

Where is Shopko Stores Operating Co LLC located?

Shopko Stores Operating Co LLC is located at 1755 N Humiston Ave, Worthington, MN 56187. The listed phone number is (507) 376-9309.

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.

When was this NPI record last updated?

The NPPES record for Shopko Stores Operating Co LLC was last updated on January 21, 2014. NPI Profile syncs with the weekly NPPES data releases published by CMS.