SHOPKO PHARMACY 018 - NPI 1245285865 - Pharmacy in West Bend, WI

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

The NPI number for Shopko Stores Operating Co LLC is 1245285865. It was assigned to this organization in the NPPES registry on May 23, 2006. The provider is doing business as Shopko Pharmacy 018.

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.

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About Shopko Pharmacy 018 NPPES

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

SHOPKO PHARMACY 018 (NPI 1245285865) is a healthcare organization registered as a community/retail pharmacy in West Bend, 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

NPI1245285865

Entity TypeOrganization

Primary Taxonomy3336C0003X

Legal Business NameSHOPKO STORES OPERATING CO LLC

Location Address1710 S MAIN STWest Bend, WI 53095-4938

Mailing Address1710 S Main StWest Bend, WI 53095-4938 · (262) 338-0222 · Fax (262) 338-3505

Phone(262) 338-0222

Fax(262) 338-3505

Organization SubpartNo

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

Enumeration DateMay 23, 2006

Last NPPES UpdateJune 6, 2014

✔ NPI 1245285865 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 · 8632042

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

1710 S MAIN ST, West Bend, WI 53095

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Other Names 1

Doing Business AsShopko Pharmacy 018

Other Identifiers 4

Medicare ID-Type Unspecified0154160160

Medicare NSC5695760054

Other5118585Ncpdp Number

Medicaid33071900WI

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.

SHOPKO STORES OPERATING CO. LLC

Eyewear Supplier