NPI 1508042425 · live from the CMS NPI Registry
Shopko Stores Operating Co LLC
Pharmacy, Community/Retail Pharmacy in Thayne, WY. National Provider Identifier 1508042425, active.
NPI record
| NPI | 1508042425 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Pharmacy, Community/Retail Pharmacy 3336C0003X |
| Practice location | 190 North Main, Thayne, WY 83127 |
| Practice phone | 307-883-4600 |
| Mailing address | Po Box 1450, Nw 5891, Minneapolis, MN 55485 |
| Enumerated | January 10, 2008 |
| Last updated | July 31, 2012 |
| Authorized official | Michael Bettiga, Executive Vice President & Coo |
| Other names | Shopko Pharmacy 527 |
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.