National Provider Identifier Database

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.


Contact Information

SHOPKO STORES OPERATING CO LLC
4161 2ND ST S
SAINT CLOUD, MN56301-3761
Phone: 320-253-3280
Fax: 320-253-5790
Website:
Specialty Taxonomy Code
* Community/Retail Pharmacy 3336C0003X
Durable Medical Equipment & Medical Supplies 332B00000X
Eyewear Supplier 332H00000X

* Indicates primary specialty

NPI Profile & details for SHOPKO STORES OPERATING CO LLC

NPI Number 1609829464
Legal business name
LBN
SHOPKO STORES OPERATING CO LLC
Authorized official MICHAEL BETTIGA - (SR. VICE PRESIDENT HEALTH SERVICES)
Entity Organization
Organization subpart No
Enumeration date 05/19/2006
Last updated 05/22/2014 - About 12 years ago
Sole proprietor1 Not specified
Identifiers
  • MN License #: 2627960
  • MN Medicaid: 0154160058
  • MN Medicaid: 578612000
  • MN Medicaid: 606234200
  • MN Medicaid: 625857300
  • Other: 2414249 NCPDP NUMBER

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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