SHOPKO PHARMACY 065
NPI 1073568234
Pharmacy - Community/Retail Pharmacy in Boise, ID

Active since May 24, 2006
8105 FAIRVIEW AVE, BOISE, ID 83704(208) 323-9297(208) 327-0622 Get Directions Write a Review

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

About Shopko Pharmacy 065 NPPES

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

SHOPKO PHARMACY 065 (NPI 1073568234) is a healthcare organization registered as a community/retail pharmacy in Boise, Idaho 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

NPI1073568234
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameSHOPKO STORES OPERATING CO LLC
Location Address8105 FAIRVIEW AVEBoise, ID 83704-8486
Mailing Address8105 Fairview AveBoise, ID 83704-8486 · (208) 323-9297 · Fax (208) 327-0622
Fax(208) 327-0622
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 24, 2006
Last NPPES UpdateMarch 21, 2014
NPI 1073568234 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 ID · 2035CP
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 · License 2035CP (ID)
8105 FAIRVIEW AVE, Boise, ID 83704

Other Names 1

Doing Business AsShopko Pharmacy 065

Other Identifiers 4

Medicaid000123400ID
Medicare NSC5695760011
Medicare ID-Type Unspecified0154160243
Other1304500Ncpdp Number

Other Providers at the Same Location NPPES

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

Eyewear Supplier
8105 FAIRVIEW AVE
BOISE, ID 83704

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 1073568234. It was assigned to this organization in the NPPES registry on May 24, 2006. The provider is doing business as Shopko Pharmacy 065.

Where is Shopko Stores Operating Co LLC located?

Shopko Stores Operating Co LLC is located at 8105 Fairview Ave, Boise, ID 83704. The listed phone number is (208) 323-9297.

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 March 21, 2014. NPI Profile syncs with the weekly NPPES data releases published by CMS.