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SHOPKO PHARMACY 095
NPI 1326085077
Pharmacy - Community/Retail Pharmacy in Boise, ID

Active since June 01, 2006
2655 BROADWAY AVE, BOISE, ID 83706(208) 345-8728(208) 343-6591 Get Directions Write a Review

NPPES record last updated: July 25, 2014. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Shopko Pharmacy 095 NPPES

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

SHOPKO PHARMACY 095 (NPI 1326085077) is a healthcare organization registered as a community/retail pharmacy in Boise, Idaho and active in the NPI registry since June 2006. The organization lists Michael J Bettiga, Sr. Vice President Health Services, as its authorized official.

NPPES Registry Identity

NPI1326085077
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameSHOPKO STORES OPERATING CO LLC
Location Address2655 BROADWAY AVEBoise, ID 83706-4721
Mailing Address2655 Broadway AveBoise, ID 83706-4721 · (208) 345-8728 · Fax (208) 343-6591
Phone(208) 345-8728
Fax(208) 343-6591
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateJune 1, 2006
Last NPPES UpdateJuly 25, 2014
✔ NPI 1326085077 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 · 2041CP
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 2041CP (ID)
2655 BROADWAY AVE, Boise, ID 83706
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Other Names 1

Doing Business AsShopko Pharmacy 095

Other Identifiers 4

Other1305108Ncpdp Number
Medicare ID-Type Unspecified1111590017
Medicaid000123000ID
Medicare NSC5695760089

Other Providers at the Same Location NPPES

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

SHOPKO STORES OPERATING CO. LLC
Eyewear Supplier
2655 BROADWAY AVE
BOISE, ID 83706
Ada County (208) 345-8812

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 1326085077. It was assigned to this organization in the NPPES registry on June 1, 2006. The provider is doing business as Shopko Pharmacy 095.

Where is Shopko Stores Operating Co LLC located?

Shopko Stores Operating Co LLC is located at 2655 Broadway Ave, Boise, ID 83706. The listed phone number is (208) 345-8728.

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 July 25, 2014. 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.