Shopko Stores Operating Co LLC

NPI #1144275884 in Lewiston, Idaho

Provider Information

NPI Number
1144275884
Entity Type
Organization
Organization Name
Shopko Stores Operating Co LLC
Primary Specialty
Pharmacy - Community/Retail Pharmacy
Enumeration Date
May 23, 2006
Last Updated
Jun 6, 2014

Practice Location

Address
2120 THAIN GRADE
State
Idaho
ZIP Code
83501-4105
Phone
(208) 746-1044

Authorized Official

Name
MR. MICHAEL J BETTIGA, RPH
Title
SR. VICE PRESIDENT HEALTH SERVICES
Phone
(920) 429-4297

Specialties & Taxonomy Codes

Specialty
Durable Medical Equipment & Medical Supplies
Pharmacy
Eyewear Supplier
Pharmacy - Community/Retail PharmacyCommunity/Retail Pharmacy

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