NPI 1780885228 · live from the CMS NPI Registry
Shopko Stores Operating Co LLC
Pharmacy, Community/Retail Pharmacy in Green River, WY. National Provider Identifier 1780885228, active.
NPI record
| NPI | 1780885228 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Pharmacy, Community/Retail Pharmacy 3336C0003X |
| Practice location | 1105 Bridger Dr, Green River, WY 82935 |
| Practice phone | 307-875-4904 |
| Enumerated | May 31, 2007 |
| Last updated | January 25, 2013 |
| Authorized official | Michael Bettiga, Executive Vice President And Coo |
| Other names | Shopko Pharmacy 760 |
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.