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SHOPKO STORES OPERATING CO. LLC
NPI 1972539740
Durable Medical Equipment & Medical Supplies in East Peoria, IL

Active since June 24, 2006
105 N MAIN ST, EAST PEORIA, IL 61611(309) 699-0632(309) 694-6426 Get Directions Write a Review

NPPES record last updated: September 11, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Sep 11, 2025, Aug 22, 2020 (2 updates tracked since 2020).

About Shopko Stores Operating Co. Llc NPPES

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

SHOPKO STORES OPERATING CO. LLC (NPI 1972539740), doing business as Shopko Pharmacy 173, is a healthcare organization registered as a durable medical equipment & medical supplies in East Peoria, Illinois and active in the NPI registry since June 2006. The organization lists Michael J Bettiga, Sr. Vice President Health Services, as its authorized official.

NPPES Registry Identity

NPI1972539740
Entity TypeOrganization
Primary Taxonomy332B00000X
Legal Business NameSHOPKO STORES OPERATING CO. LLC
Location Address105 N MAIN STEast Peoria, IL 61611-2543
Mailing Address105 N Main StEast Peoria, IL 61611-2543 · (309) 699-0632 · Fax (309) 694-6426
Phone(309) 699-0632
Fax(309) 694-6426
Organization SubpartNo
Authorized OfficialMichael J BettigaSr. Vice President Health Services · (920) 429-4297
Enumeration DateJune 24, 2006
Last NPPES UpdateSeptember 11, 20252 updates tracked since enumeration
✔ NPI 1972539740 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDurable Medical Equipment & Medical SuppliesSuppliers
Taxonomy Code332B00000X
Definition
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.
Also ListedPharmacy · Community/Retail PharmacyTaxonomy 3336C0003X

Other Names 1

Doing Business AsShopko Pharmacy 173

Other Identifiers 2

Other1472048Ncpdp Number
Medicaid410985054173IL

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
105 N MAIN ST
EAST PEORIA, IL 61611
Tazewell County (309) 694-6470

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 1972539740. It was assigned to this organization in the NPPES registry on June 24, 2006. The provider is doing business as ShopKo Pharmacy 173.

Where is Shopko Stores Operating Co. LLC located?

Shopko Stores Operating Co. LLC is located at 105 N Main St, East Peoria, IL 61611. The listed phone number is (309) 699-0632.

What is Shopko Stores Operating Co. LLC's specialty?

The primary specialty registered for this NPI is Durable Medical Equipment & Medical Supplies with taxonomy code 332B00000X.

When was this NPI record last updated?

The NPPES record for Shopko Stores Operating Co. LLC was last updated on September 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months 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.