Shopko Stores Operating Co LLC
Shopko Stores Operating Co LLC is a healthcare organization registered as Community/Retail Pharmacy in Bend, OR, holding Type 2 (organization) NPI 1104878628 since 2006. The authorized official on file is Michael Bettiga, Sr. Vice President Health Services.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1104878628 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Shopko Stores Operating Co LLC |
| Other name | <Unavail> |
| Practice address | 60 NE BEND RIVER MALL DR, Bend, OR, 97701 |
| Phone | 5413856076 |
| Fax | 5413859209 |
| Enumeration date | 2006-05-16 |
| Last updated in NPPES | 2013-10-28 |
Authorized official
| Name | Michael Bettiga |
|---|---|
| Title | Sr. Vice President Health Services |
| Phone | 9204294297 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 332B00000X | Durable Medical Equipment & Medical Supplies | Secondary | — | — |
| 332H00000X | Eyewear Supplier | Secondary | — | — |
| 3336C0003X | Community/Retail Pharmacy | Primary | 1084 | OR |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3809956 | Other | — | NCPDP NUMBER |
| 278350 | Medicaid | OR | — |
| 278377 | Medicaid | OR | — |
| 000682 | Medicaid | OR | — |
Copy-ready billing details
Provider: Shopko Stores Operating Co LLC NPI: 1104878628 Taxonomy: 3336C0003X (Community/Retail Pharmacy) Address: 60 NE BEND RIVER MALL DR, Bend, OR, 97701
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1023069499 | Shopko Stores Operating Co LLC | Organization | Eyewear Supplier | Bend, OR |
| 1699048256 | Jonathan Carney | Individual | Pharmacist | Bend, OR |
| 1063785277 | Kerst Bosma | Individual | Pharmacist | Bend, OR |
| 1275967382 | Gerald Radant | Individual | Pharmacist | Bend, OR |
Verify this record
Cross-check NPI 1104878628 against the authoritative CMS record: view Shopko Stores Operating Co LLC on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
What is a Type 2 NPI?
What type of organization is Shopko Stores Operating Co LLC?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2013-10-28.