Shopko Pharmacy 174

LBN: Shopko Stores Operating Co. Llc
Shopko Pharmacy 174 is an health care organization with primary practice located at 2323 W Pioneer Pkwy , Peoria IL 61615-1833. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Durable Medical Equipment & Medical Supplies, Suppliers / Community/Retail Pharmacy. Suppliers / Durable Medical Equipment & Medical Supplies is the primary health care specialty. Shopko Stores Operating Co. Llc can be contacted via phone (309) 691-4682, or through Bettiga, Michael J via phone (920) 429-4297.

Contact Information

Primary practice address
2323 W Pioneer Pkwy Peoria IL 61615-1833
Phone: (309) 691-4682
Fax: (309) 691-4807
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 / Community/Retail Pharmacy 3336C0003X Illinois

Profile Details

NPI number 1538195300
LBN Legal business name Shopko Stores Operating Co. Llc
DBA Doing business as Shopko Pharmacy 174
Authorized official Bettiga, Michael J RPH
Entity Organization
Organization subpart 1 No
Enumeration date Jun 24th, 2006
Last updated Aug 22nd, 2020 - about 4 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 1538195300 NPPES
Illinois MEDICAID 410985054174
Illinois Other 1473014

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