SHOPKO STORES OPERATING CO LLC

Community/Retail Pharmacy

A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

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Contact Information

SHOPKO STORES OPERATING CO LLC

1850 E MADISON AVE
MANKATO, MN 56001-5448

Phone: 507-387-6515
Fax: 507-387-1680
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
Eyewear Supplier	332H00000X	87	All Other Suppliers

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NPI Profile & details for SHOPKO STORES OPERATING CO LLC

NPI Number 1518910371

LBN Legal business name SHOPKO STORES OPERATING CO LLC

Authorized official MICHAEL BETTIGA - (SR. VICE PRESIDENT HEALTH SERVICES)

Entity Organization

Organization subpart ¹ No

Enumeration date 05/19/2006

Last updated 03/13/2014 - About 12 years ago

Identifiers

MN	License #	2627973
MN	Medicaid	077472000
MN	Medicaid	234058500
MN	Medicaid	808787300
	Other	2417144	NCPDP NUMBER

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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