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SHOPKO PHARMACY 093
NPI 1104878628
Pharmacy - Community/Retail Pharmacy in Bend, OR

Active since May 16, 2006
60 NE BEND RIVER MALL DR, BEND, OR 97701(541) 385-6076(541) 385-9209 Get Directions Write a Review

NPPES record last updated: October 28, 2013. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Shopko Pharmacy 093 NPPES

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

SHOPKO PHARMACY 093 (NPI 1104878628) is a healthcare organization registered as a community/retail pharmacy in Bend, Oregon 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

NPI1104878628
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameSHOPKO STORES OPERATING CO LLC
Location Address60 NE BEND RIVER MALL DRBend, OR 97701-7528
Mailing Address60 Ne Bend River Mall DrBend, OR 97701-7528 · (541) 385-6076 · Fax (541) 385-9209
Phone(541) 385-6076
Fax(541) 385-9209
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 16, 2006
Last NPPES UpdateOctober 28, 2013
✔ NPI 1104878628 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 OR · 1084
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
60 NE BEND RIVER MALL DR, Bend, OR 97701
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Other Names 1

Doing Business AsShopko Pharmacy 093

Other Identifiers 6

Other3809956Ncpdp Number
Medicaid278350OR
Medicaid000682OR
Medicaid278377OR
Medicare ID-Type Unspecified0154160025
Medicare NSC5695760101

Other Providers at the Same Location NPPES 4

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

SHOPKO STORES OPERATING CO LLC
Eyewear Supplier
60 NE BEND RIVER MALL DR
BEND, OR 97701
Deschutes County (541) 385-6079
MR. KERST BOSMA RPH
Pharmacist
60 NE BEND RIVER MALL DR
BEND, OR 97701
Deschutes County (541) 385-6076
MR. GERALD DANA RADANT RPH
Pharmacist
60 NE BEND RIVER MALL DR
BEND, OR 97701
Deschutes County (541) 385-6076
JONATHAN CARNEY
Pharmacist
60 NE BEND RIVER MALL DR
BEND, OR 97701
Deschutes County (541) 385-6076

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 1104878628. It was assigned to this organization in the NPPES registry on May 16, 2006. The provider is doing business as Shopko Pharmacy 093.

Where is Shopko Stores Operating Co LLC located?

Shopko Stores Operating Co LLC is located at 60 NE Bend River Mall Dr, Bend, OR 97701. The listed phone number is (541) 385-6076.

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 October 28, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.