NPI 1124067095 · live from the CMS NPI Registry
Shopko Stores Operating Co LLC
Pharmacy, Community/Retail Pharmacy in Powell, WY. National Provider Identifier 1124067095, active.
NPI record
| NPI | 1124067095 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Pharmacy, Community/Retail Pharmacy 3336C0003X |
| Practice location | 1005 W Coulter Ave, Powell, WY 82435 |
| Practice phone | 307-754-2755 |
| Enumerated | June 6, 2006 |
| Last updated | October 19, 2012 |
| Authorized official | Michael Bettiga, Executive Vice President & Coo |
| Other names | Shopko Pharmacy 772 |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | — |
| Pharmacy | 333600000X | — |
| Pharmacy, Community/Retail Pharmacy primary | 3336C0003X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.