NPI 1104878628

Shopko Stores Operating Co LLC

Organisation Community/Retail Pharmacy Bend, OR

Practice location

Address: 60 NE Bend River Mall Dr, Bend, OR 97701-7528
Phone: (541) 385-6076
Fax: (541) 385-9209

Authorised official

Name: Michael J Bettiga
Title: Sr. Vice President Health Services
Phone: (920) 429-4297

Registered specialties (3)

Community/Retail Pharmacy Primary

Suppliers Taxonomy 3336C0003X Licence 1084 (OR)

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Durable Medical Equipment & Medical Supplies

Suppliers Taxonomy 332B00000X

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Eyewear Supplier

Suppliers Taxonomy 332H00000X

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Registry record

NPI: 1104878628
Entity type: Organization
NPI issued: 16 May 2006
Record last updated: 28 Oct 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.