Shopko Pharmacy 173
LBN: Shopko Stores Operating Co. Llc
Shopko Pharmacy 173 is an health care organization with primary practice located at 105 N Main St , East Peoria IL 61611-2543. 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) 699-0632, or through Bettiga, Michael J via phone (920) 429-4297.
Contact Information
Primary practice address
105 N Main St
East Peoria IL 61611-2543
Phone: (309) 699-0632
Fax: (309) 694-6426
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Durable Medical Equipment & Medical Supplies | 332B00000X | ||
| Suppliers / Community/Retail Pharmacy | 3336C0003X | Illinois |
Profile Details
| NPI number | 1972539740 |
|---|---|
| LBN Legal business name | Shopko Stores Operating Co. Llc |
| DBA Doing business as | Shopko Pharmacy 173 |
| 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1972539740 | NPPES |
| Other | 1472048 | NCPDP NUMBER | |
| MEDICAID | 410985054173 | NCPDP NUMBER |
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