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SHOPKO PHARMACY 617
NPI 1811941586
Pharmacy - Community/Retail Pharmacy in Wautoma, WI

Active since May 19, 2006
N2585 PLAZA RD, WAUTOMA, WI 54982(920) 787-2090(920) 787-4605 Get Directions Write a Review

NPPES record last updated: September 4, 2012. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Shopko Pharmacy 617 NPPES

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

SHOPKO PHARMACY 617 (NPI 1811941586) is a healthcare organization registered as a community/retail pharmacy in Wautoma, Wisconsin and active in the NPI registry since May 2006. The organization lists Michael Bettiga, Executive Vice President & Coo, as its authorized official.

NPPES Registry Identity

NPI1811941586
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameSHOPKO STORES OPERATING CO LLC
Location AddressN2585 PLAZA RDWautoma, WI 54982-7706
Mailing AddressN2585 Plaza RdWautoma, WI 54982-7706 · (920) 787-2090 · Fax (920) 787-4605
Phone(920) 787-2090
Fax(920) 787-4605
Organization SubpartNo
Authorized OfficialMichael BettigaExecutive Vice President & Coo · (920) 429-4297
Enumeration DateMay 19, 2006
Last NPPES UpdateSeptember 4, 2012
✔ NPI 1811941586 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
N2585 PLAZA RD, Wautoma, WI 54982
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Other Names 1

Doing Business AsShopko Pharmacy 617

Other Identifiers 2

Other0459230035Medicare Id - Type Unspecified
Medicare NSC5695760183

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
N2585 PLAZA RD
WAUTOMA, WI 54982
Waushara County (920) 787-7709

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 1811941586. It was assigned to this organization in the NPPES registry on May 19, 2006. The provider is doing business as Shopko Pharmacy 617.

Where is Shopko Stores Operating Co LLC located?

Shopko Stores Operating Co LLC is located at N2585 Plaza Rd, Wautoma, WI 54982. The listed phone number is (920) 787-2090.

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 September 4, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.