SHOPKO STORES OPERATING CO LLC NPI 1619928330

NPI Information

  • NPI: 1619928330
  • Provider Name: SHOPKO STORES OPERATING CO LLC
  • Classification: Pharmacy - 3336C0003X
  • Specialization: Community/Retail Pharmacy
  • Entity Type: Organization
  • Doing Business As: SHOPKO PHARMACY 052
  • Address: 615 S MONROE AVE
    MASON CITY, IA
    ZIP 50401
  • Phone: (641) 424-4302

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NPI Details

SHOPKO STORES OPERATING CO LLC is a community/retail pharmacy pharmacy in Mason City, IA. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. SHOPKO STORES OPERATING CO LLC NPI is 1619928330. The provider is registered as an organization entity type.
The provider Is Doing Business As Shopko Pharmacy 052.

The provider's business location address is:

615 S MONROE AVE
MASON CITY, IA
ZIP 50401-061
Phone: (641) 424-4302
Fax: (641) 424-8537

The provider's authorized official is Michael J Bettiga .
The authorized official title is Sr. Vice President Health Services and has the following contact phone number (920) 429-4297.

The enumeration date for this NPI number is 5/15/2006 and was last updated on 6/6/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1332B00000XDurable Medical Equipment & Medical SuppliesNo
2332H00000XEyewear SupplierNo
33336C0003XPharmacyCommunity/Retail Pharmacy819IOWAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1201016000MEDICAIDMINNESOTA
2743927000MEDICAIDMINNESOTA
30154160017MEDICARE ID-TYPE UNSPECIFIED
41614494OTHERNCPDP NUMBER
50227249MEDICAIDIOWA
60495168MEDICAIDIOWA
75695760052MEDICARE NSC

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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