Shopko Stores Operating Co. LLC

NPI #1477505485 in Boise, Idaho

Provider Information

NPI Number: 1477505485
Entity Type: Organization
Organization Name: Shopko Stores Operating Co. LLC
Primary Specialty: Eyewear Supplier
Enumeration Date: May 17, 2006
Last Updated: Aug 3, 2009

Practice Location

Address: 2655 BROADWAY AVE
City: Boise
State: Idaho
ZIP Code: 83706-4721
Phone: (208) 345-8812

Authorized Official

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

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Technician/Technologist - Optician — Optician	156FX1800X
Eyewear Supplier	332H00000X	Primary

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