1. Home
  2. Directory
  3. Utah
  4. Brigham City
  5. Pharmacy
  6. NPI Profile

SHOPKO PHARMACY 104
NPI 1649221623
Pharmacy - Community/Retail Pharmacy in Brigham City, UT

Active since May 13, 2006
747 S MAIN ST, BRIGHAM CITY, UT 84302(435) 723-1600(435) 723-8213 Get Directions Write a Review

NPPES record last updated: August 14, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Shopko Pharmacy 104 NPPES

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

SHOPKO PHARMACY 104 (NPI 1649221623) is a healthcare organization registered as a community/retail pharmacy in Brigham City, Utah 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

NPI1649221623
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameSHOPKO STORES OPERATING CO LLC
Location Address747 S MAIN STBrigham City, UT 84302-3359
Mailing Address747 S Main StBrigham City, UT 84302-3359 · (435) 723-1600 · Fax (435) 723-8213
Phone(435) 723-1600
Fax(435) 723-8213
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 13, 2006
Last NPPES UpdateAugust 14, 2008
✔ NPI 1649221623 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
License✔ Licensed in UT · 1323891703
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
747 S MAIN ST, Brigham City, UT 84302
Open in Google Maps ↗

Other Names 1

Doing Business AsShopko Pharmacy 104

Other Identifiers 6

Medicaid410985054179UT
Medicare ID-Type Unspecified0154160241
Medicaid804256000ID
Medicaid=========007UT
Other4607163Ncpdp Number
Medicare NSC5695760031

Other Providers at the Same Location NPPES 2

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

DR. SCOTT ROBERTS HADERLIE O.D.
Optometrist
747 S MAIN ST
BRIGHAM CITY, UT 84302
Box Elder County (435) 723-1800
SHOPKO STORES OPERATING CO. LLC
Eyewear Supplier
747 S MAIN ST
BRIGHAM CITY, UT 84302
Box Elder County (435) 723-1800

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 1649221623. It was assigned to this organization in the NPPES registry on May 13, 2006. The provider is doing business as Shopko Pharmacy 104.

Where is Shopko Stores Operating Co LLC located?

Shopko Stores Operating Co LLC is located at 747 S Main St, Brigham City, UT 84302. The listed phone number is (435) 723-1600.

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 August 14, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.