Shopko Pharmacy 629

LBN: Shopko Stores Operating Co Llc
Shopko Pharmacy 629 is an health care organization with primary practice located at 1500 E Sheridan St , Ely MN 55731-1229. The organization recently has 3 registered licenses in different health care specialties including Suppliers / Durable Medical Equipment & Medical Supplies, Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Shopko Stores Operating Co Llc can be contacted via phone (218) 365-7123, or through Bettiga, Michael via phone (920) 429-4297.

Contact Information

Primary practice address
1500 E Sheridan St Ely MN 55731-1229
Phone: (218) 365-7123
Fax: (218) 365-7124
Website:
Map and Directions
Authorized official contact:
Name: Bettiga, Michael RPH
Phone: (920) 429-4297

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Durable Medical Equipment & Medical Supplies 332B00000X
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X

Profile Details

NPI number 1629021514
LBN Legal business name Shopko Stores Operating Co Llc
DBA Doing business as Shopko Pharmacy 629
Authorized official Bettiga, Michael RPH
Entity Organization
Organization subpart 1 No
Enumeration date May 19th, 2006
Last updated Aug 21st, 2012 - about 14 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 1629021514 NPPES
Other 0459230078 MEDICARE ID - TYPE UNSPECIFIED

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