Shopko Pharmacy 119

LBN: Shopko Stores Operating Co Llc
Shopko Pharmacy 119 is an health care organization with primary practice located at 1350 N Galena Ave , Dixon IL 61021-1010. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Durable Medical Equipment & Medical Supplies, Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Shopko Stores Operating Co Llc can be contacted via phone (815) 284-4127, or through Bettiga, Michael J via phone (920) 429-4297.

Contact Information

Primary practice address
1350 N Galena Ave Dixon IL 61021-1010
Fax: (815) 284-6094
Website:
Authorized official contact:
Name: Bettiga, Michael J RPH

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Durable Medical Equipment & Medical Supplies 332B00000X
Suppliers / Community/Retail Pharmacy 3336C0003X 05401587 Illinois

Profile Details

NPI number 1376579334
LBN Legal business name Shopko Stores Operating Co Llc
DBA Doing business as Shopko Pharmacy 119
Authorized official Bettiga, Michael J RPH
Entity Organization
Organization subpart 1 No
Enumeration date Jun 23rd, 2006
Last updated Aug 14th, 2008 - about 18 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1376579334 NPPES
Other 1463809 NCPDP NUMBER
MEDICAID 410985054001 NCPDP NUMBER

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