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SHOPKO PHARMACY 612
NPI 1407127889
Pharmacy - Community/Retail Pharmacy in Lake Mills, WI

Active since January 18, 2012
203 N MAIN ST, LAKE MILLS, WI 53551(920) 648-3455(920) 648-2712 Get Directions Write a Review

NPPES record last updated: April 20, 2012. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Shopko Pharmacy 612 NPPES

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

SHOPKO PHARMACY 612 (NPI 1407127889) is a healthcare organization registered as a community/retail pharmacy in Lake Mills, Wisconsin and active in the NPI registry since January 2012. The organization lists Michael Bettiga, Executive Vice President And Coo, as its authorized official.

NPPES Registry Identity

NPI1407127889
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameSHOPKO STORES OPERATING CO LLC
Location Address203 N MAIN STLake Mills, WI 53551-1610
Mailing Address203 N Main StLake Mills, WI 53551-1610 · (920) 648-3455 · Fax (920) 648-2712
Phone(920) 648-3455
Fax(920) 648-2712
Organization SubpartNo
Authorized OfficialMichael BettigaExecutive Vice President And Coo · (920) 429-4297
Enumeration DateJanuary 18, 2012
Last NPPES UpdateApril 20, 2012
✔ NPI 1407127889 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
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 ListedPharmacyTaxonomy 333600000X
203 N MAIN ST, Lake Mills, WI 53551
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Other Names 1

Doing Business AsShopko Pharmacy 612

Other Identifiers 2

Medicaid1407127889WI
Medicare NSC5695760156

Other Providers at the Same Location NPPES 3

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

AURORA PHARMACY INC
Pharmacy
203 N MAIN ST
LAKE MILLS, WI 53551
Jefferson County (920) 648-3455
MICHAEL SCHILLING
Pharmacist
203 N MAIN ST
LAKE MILLS, WI 53551
Jefferson County (920) 648-3455
JANE MARTY
Pharmacist
203 N MAIN ST
LAKE MILLS, WI 53551
Jefferson County (920) 648-3455

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 1407127889. It was assigned to this organization in the NPPES registry on January 18, 2012. The provider is doing business as Shopko Pharmacy 612.

Where is Shopko Stores Operating Co LLC located?

Shopko Stores Operating Co LLC is located at 203 N Main St, Lake Mills, WI 53551. The listed phone number is (920) 648-3455.

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 April 20, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.