MEDICARE: SHOPKO STORES OPERATING CO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	332H00000X	Eyewear Supplier
3	3336C0003X	Community/Retail Pharmacy	CF00058639	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4923389	OTHER	NCPDP NUMBER
3	0038601	OTHER	WA LABOR & INDUSTRY
4	0215811	OTHER	WA LABOR & INDUSTRY

General Provider Information

NPI Number	:	1871533208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHOPKO STORES OPERATING CO LLC

Provider Business Mailing Address
First Line	:	1340 N WENATCHEE AVE
Second Line	:
City	:	WENATCHEE
State	:	WA
Zip	:	98801-1558
Country	:	US
Telephone Number	:	509-664-5111
Fax Number	:	509-663-9006

Provider Business Practice Location Address
First Line	:	1340 N WENATCHEE AVE
Second Line	:
City	:	WENATCHEE
State	:	WA
Zip	:	98801-1558
Country	:	US
Telephone Number	:	509-664-5111
Fax Number	:	509-663-9006

Authorized Official
Title or Position	:	SR. VICE PRESIDENT HEALTH SERVICES
Name	:	MR. MICHAEL J BETTIGA
Credential	:	RPH
Telephone Number	:	920-429-4297

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	06/06/2014

Similar Medicare Providers

1386696383 — SHOPKO STORES OPERATING CO. LLC
Practice Location Address:

1340 N WENATCHEE AVE
WENATCHEE, WA
98801-1558

Practice Phone: 509-663-8868
Practice Fax:

1740232669 — DR. GLENN H ISAACSON O.D.
Practice Location Address:

1340 N WENATCHEE AVE
WENATCHEE, WA
98801-1558

Practice Phone: 509-663-8868
Practice Fax: 509-663-9006

1285982736 — MS. DONNA MARIE MELLISON PHARMACIST MANAGER
Practice Location Address:

1340 N WENATCHEE AVE
WENATCHEE, WA
98801-1558

Practice Phone: 509-664-5111
Practice Fax:

1144760794 — DR. TRAVIS IKSIC PHARMD
Practice Location Address:

1340 N WENATCHEE AVE
WENATCHEE, WA
98801-1558

Practice Phone: 509-664-5111
Practice Fax: 509-663-9006

1588937163 — TAYLOR STIMMEL D.C.
Practice Location Address:

1558 N GROVER AVE
EAST WENATCHEE, WA
98802-8346

Practice Phone: 206-453-9853
Practice Fax:

1033776059 — DR. CRISTINA MARIE PRATT MD
Practice Location Address:

707 N EMERSON AVE
WENATCHEE, WA
98801-2032

Practice Phone: 509-662-1511
Practice Fax:

Directions to “SHOPKO STORES OPERATING CO LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.