Shopko Pharmacy 097

LBN: Shopko Stores Operating Co Llc
Shopko Pharmacy 097 is an health care organization with primary practice located at 4850 W 3500 S , West Valley City UT 84120-2927. The organization recently has 3 registered licenses in different health care specialties including Suppliers / Durable Medical Equipment & Medical Supplies, Suppliers / Eyewear Supplier (Equipment, not the service), Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Shopko Stores Operating Co Llc can be contacted via phone (801) 966-6500, or through Bettiga, Michael J via phone (920) 429-4297.

Contact Information

Primary practice address
4850 W 3500 S West Valley City UT 84120-2927
Phone: (801) 966-6500
Fax: (801) 966-8805
Website:
Map and Directions
Authorized official contact:
Name: Bettiga, Michael J RPH
Phone: (920) 429-4297

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Durable Medical Equipment & Medical Supplies 332B00000X
Suppliers / Eyewear Supplier (Equipment, not the service) 332H00000X
Suppliers / Community/Retail Pharmacy 3336C0003X 1320601703 Utah

Profile Details

NPI number 1194776179
LBN Legal business name Shopko Stores Operating Co Llc
DBA Doing business as Shopko Pharmacy 097
Authorized official Bettiga, Michael J RPH
Entity Organization
Organization subpart 1 No
Enumeration date May 13th, 2006
Last updated Aug 27th, 2013 - about 11 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1194776179 NPPES
Utah MEDICAID 410985054151
Utah Other 4606945

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