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SHOPKO PHARMACY 017
NPI 1609829464
Pharmacy - Community/Retail Pharmacy in Saint Cloud, MN

Active since May 19, 2006
4161 2ND ST S, SAINT CLOUD, MN 56301(320) 253-3280(320) 253-5790 Get Directions Write a Review

NPPES record last updated: May 22, 2014. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Shopko Pharmacy 017 NPPES

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

SHOPKO PHARMACY 017 (NPI 1609829464) is a healthcare organization registered as a community/retail pharmacy in Saint Cloud, Minnesota 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

NPI1609829464
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameSHOPKO STORES OPERATING CO LLC
Location Address4161 2ND ST SSaint Cloud, MN 56301-3761
Mailing Address4161 2nd St SSaint Cloud, MN 56301-3761 · (320) 253-3280 · Fax (320) 253-5790
Phone(320) 253-3280
Fax(320) 253-5790
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 19, 2006
Last NPPES UpdateMay 22, 2014
✔ NPI 1609829464 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 MN · 2627960
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
4161 2ND ST S, Saint Cloud, MN 56301
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Other Names 1

Doing Business AsShopko Pharmacy 017

Other Identifiers 7

Medicaid0154160058MN
Other2414249Ncpdp Number
Medicaid625857300MN
Medicaid606234200MN
Medicare NSC5695760020
Medicaid578612000MN
Medicare ID-Type Unspecified0154160098

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.

LORI ANN KEPPERS PHARMD, RPH
Pharmacist
4161 2ND ST S
SAINT CLOUD, MN 56301
Stearns County (320) 253-3280
LESLIE KIEL
Pharmacist
4161 2ND ST S
SAINT CLOUD, MN 56301
Stearns County (320) 253-3280
SHOPKO STORES OPERATING CO. LLC
Eyewear Supplier
4161 2ND ST S
SAINT CLOUD, MN 56301
Stearns County (320) 253-5994
MICHAEL NEUWIRTH
Pharmacist
4161 2ND ST S
SAINT CLOUD, MN 56301
Stearns County (320) 253-3280
MR. BRYAN DAVID LORENZ OD
Optometrist
4161 2ND ST S, SHOPKO OPTICAL
SAINT CLOUD, MN 56301
Stearns County (320) 253-5994

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 1609829464. It was assigned to this organization in the NPPES registry on May 19, 2006. The provider is doing business as Shopko Pharmacy 017.

Where is Shopko Stores Operating Co LLC located?

Shopko Stores Operating Co LLC is located at 4161 2nd St S, Saint Cloud, MN 56301. The listed phone number is (320) 253-3280.

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 May 22, 2014. NPI Profile syncs with the weekly NPPES data releases published by CMS.