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Contact Information

SHOPKO STORES OPERATING CO LLC
300 JAKE ST
PERHAM, MN56573
 Phone: 218-346-7751
 Fax: 218-346-7752
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for SHOPKO STORES OPERATING CO LLC

NPI Number 1023063757
LBN Legal business name SHOPKO STORES OPERATING CO LLC
Authorized official MICHAEL BETTIGA - (EXECUTIVE VICE PRESIDENT & COO)
Entity Organization
Organization subpart 1 No
Enumeration date 05/23/2006
Last updated 09/24/2012 - About 14 years ago
Identifiers
MN Medicaid 208187000
MN Medicaid 300559300
Other 2421511 NCPDP
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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