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SHOPKO PHARMACY 615
NPI 1821042003
Pharmacy - Community/Retail Pharmacy in Clintonville, WI

Active since May 20, 2006
291 S MAIN ST, CLINTONVILLE, WI 54929(715) 823-2350(715) 823-2541 Get Directions Write a Review

NPPES record last updated: September 24, 2012. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Shopko Pharmacy 615 NPPES

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

SHOPKO PHARMACY 615 (NPI 1821042003) is a healthcare organization registered as a community/retail pharmacy in Clintonville, 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

NPI1821042003
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameSHOPKO STORES OPERATING CO LLC
Location Address291 S MAIN STClintonville, WI 54929-1604
Mailing Address291 S Main StClintonville, WI 54929-1604 · (715) 823-2350 · Fax (715) 823-2541
Phone(715) 823-2350
Fax(715) 823-2541
Organization SubpartNo
Authorized OfficialMichael BettigaExecutive Vice President & Coo · (920) 429-4297
Enumeration DateMay 20, 2006
Last NPPES UpdateSeptember 24, 2012
✔ NPI 1821042003 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
291 S MAIN ST, Clintonville, WI 54929
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Other Names 1

Doing Business AsShopko Pharmacy 615

Other Identifiers 5

Other5127267Ncpdp Number
Medicare NSC5695760195
Medicaid33268600WI
Medicare ID-Type Unspecified5694490087
Medicare ID-Type Unspecified0459230113

Other Providers at the Same Location NPPES 4

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

LEONARD J PURULL RPH
Pharmacist
291 S MAIN ST
CLINTONVILLE, WI 54929
Waupaca County (715) 823-2350
BOBBI R. BRAHAN PHARMD
Pharmacist
291 S MAIN ST
CLINTONVILLE, WI 54929
Waupaca County (715) 823-2350
MRS. CASEY ANNE BARTZ PHARM D
Pharmacist
291 S MAIN ST
CLINTONVILLE, WI 54929
Waupaca County (715) 823-2350
CURTIS LEIDER
Pharmacist
291 S MAIN ST
CLINTONVILLE, WI 54929
Waupaca County (715) 823-2350

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 1821042003. It was assigned to this organization in the NPPES registry on May 20, 2006. The provider is doing business as Shopko Pharmacy 615.

Where is Shopko Stores Operating Co LLC located?

Shopko Stores Operating Co LLC is located at 291 S Main St, Clintonville, WI 54929. The listed phone number is (715) 823-2350.

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 24, 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.