Shopko Pharmacy 760

LBN: Shopko Stores Operating Co Llc
Shopko Pharmacy 760 is an health care organization with primary practice located at 1105 Bridger Dr , Green River WY 82935-5895. 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 (307) 875-4904, or through Bettiga, Michael via phone (920) 429-4297.

Contact Information

Primary practice address
1105 Bridger Dr Green River WY 82935-5895
Phone: (307) 875-4904
Fax: (307) 875-0192
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 1780885228
LBN Legal business name Shopko Stores Operating Co Llc
DBA Doing business as Shopko Pharmacy 760
Authorized official Bettiga, Michael RPH
Entity Organization
Organization subpart 1 No
Enumeration date May 31st, 2007
Last updated Jan 25th, 2013 - about 13 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 1780885228 NPPES
Other 5204007 NCPDP NUMBER
MEDICAID 1780885228 NCPDP NUMBER

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