Shopko Stores Operating Co LLC
Shopko Stores Operating Co LLC is a healthcare organization registered as Community/Retail Pharmacy in Powell, WY, holding Type 2 (organization) NPI 1124067095 since 2006. The authorized official on file is Michael Bettiga, Executive Vice President & Coo.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1124067095 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Shopko Stores Operating Co LLC |
| Other name | <Unavail> |
| Practice address | 1005 W COULTER AVE, Powell, WY, 82435 |
| Phone | 3077542755 |
| Fax | 3077547915 |
| Enumeration date | 2006-06-06 |
| Last updated in NPPES | 2012-10-19 |
Authorized official
| Name | Michael Bettiga |
|---|---|
| Title | Executive Vice President & Coo |
| Phone | 9204294297 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 332B00000X | Durable Medical Equipment & Medical Supplies | Secondary | — | — |
| 333600000X | Pharmacy | Secondary | — | — |
| 3336C0003X | Community/Retail Pharmacy | Primary | — | — |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 123286000 | Medicaid | WY | — |
| 5203776 | Other | — | NCPDP |
| 117709500 | Medicaid | WY | — |
| 123286001 | Medicaid | WY | — |
Copy-ready billing details
Provider: Shopko Stores Operating Co LLC NPI: 1124067095 Taxonomy: 3336C0003X (Community/Retail Pharmacy) Address: 1005 W COULTER AVE, Powell, WY, 82435
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1164772174 | Jason Bischoff | Individual | Pharmacist | Powell, WY |
| 1518511468 | Ramsey Lamb | Individual | Pharmacist | Powell, WY |
| 1073235222 | Albertsons LLC | Organization | Community/Retail Pharmacy | Powell, WY |
| 1144005554 | Taylor Olson | Individual | Pharmacist | Powell, WY |
Verify this record
Cross-check NPI 1124067095 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
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Where is Shopko Stores Operating Co LLC located?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2012-10-19.