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SHOPKO PHARMACY 014
NPI 1902852353
Pharmacy - Community/Retail Pharmacy in Beaver Dam, WI

Active since May 26, 2006
822 PARK AVE, BEAVER DAM, WI 53916(920) 887-7461(920) 887-0725 Get Directions Write a Review

NPPES record last updated: June 6, 2014. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Shopko Pharmacy 014 NPPES

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

SHOPKO PHARMACY 014 (NPI 1902852353) is a healthcare organization registered as a community/retail pharmacy in Beaver Dam, Wisconsin 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

NPI1902852353
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameSHOPKO STORES OPERATING CO LLC
Location Address822 PARK AVEBeaver Dam, WI 53916-2266
Mailing Address822 Park AveBeaver Dam, WI 53916-2266 · (920) 887-7461 · Fax (920) 887-0725
Phone(920) 887-7461
Fax(920) 887-0725
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateMay 26, 2006
Last NPPES UpdateJune 6, 2014
✔ NPI 1902852353 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
License✔ Licensed in WI · 8633042
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
Also ListedPharmacyTaxonomy 333600000X
822 PARK AVE, Beaver Dam, WI 53916
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Other Names 1

Doing Business AsShopko Pharmacy 014

Other Identifiers 4

Other5105247Ncpdp Number
Medicare ID-Type Unspecified0154160186
Medicaid33133600WI
Medicare NSC5695760085

Other Providers at the Same Location NPPES 8

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

MIKE LEAHAN RPH
Pharmacist
822 PARK AVE
BEAVER DAM, WI 53916
Dodge County (920) 887-7511
JESSAMYN KOVACS O.D.
Optometrist
822 PARK AVE
BEAVER DAM, WI 53916
Dodge County (920) 887-3791
MR. ANTHONY THOMAS BRIDGEMAN RPH
Pharmacist
822 PARK AVE
BEAVER DAM, WI 53916
Dodge County (608) 887-7511
DR. BRIAN L SCHROEDL O.D.
Optometrist
822 PARK AVE
BEAVER DAM, WI 53916
Dodge County (920) 887-3791
SHOPKO STORES OPERATING CO. LLC
Eyewear Supplier
822 PARK AVE
BEAVER DAM, WI 53916
Dodge County (920) 887-3791
DR. MICHAEL DULL II PHARMD
Pharmacist
822 PARK AVE
BEAVER DAM, WI 53916
Dodge County (920) 887-7511
MR. KEVIN DALE WRIGHT RPH
Pharmacist
822 PARK AVE
BEAVER DAM, WI 53916
Dodge County (920) 887-7461
DR. MARK E. JAMES O.D.
Optometrist
822 PARK AVE
BEAVER DAM, WI 53916
Dodge County (920) 887-3791

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 1902852353. It was assigned to this organization in the NPPES registry on May 26, 2006. The provider is doing business as Shopko Pharmacy 014.

Where is Shopko Stores Operating Co LLC located?

Shopko Stores Operating Co LLC is located at 822 Park Ave, Beaver Dam, WI 53916. The listed phone number is (920) 887-7461.

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 June 6, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.