Shopko Stores Operating Co LLC
Shopko Stores Operating Co LLC is a healthcare organization registered as Community/Retail Pharmacy in Chubbuck, ID, holding Type 2 (organization) NPI 1255378907 since 2006. The authorized official on file is Michael Bettiga, Sr. Vice President Health Services.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1255378907 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Shopko Stores Operating Co LLC |
| Other name | <Unavail> |
| Practice address | 4215 YELLOWSTONE AVE, Chubbuck, ID, 83202 |
| Phone | 2082376828 |
| Fax | 2082388371 |
| Enumeration date | 2006-06-01 |
| Last updated in NPPES | 2014-06-06 |
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 | — | — |
| 333600000X | Pharmacy | Secondary | 2039CP | ID |
| 332H00000X | Eyewear Supplier | Secondary | — | — |
| 3336C0003X | Community/Retail Pharmacy | Primary | 2039CP | ID |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000123300 | Medicaid | ID | — |
| 1304550 | Other | — | NCPDP NUMBER |
Copy-ready billing details
Provider: Shopko Stores Operating Co LLC NPI: 1255378907 Taxonomy: 3336C0003X (Community/Retail Pharmacy) Address: 4215 YELLOWSTONE AVE, Chubbuck, ID, 83202
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1336191436 | Shopko Stores Operating Co. LLC | Organization | Eyewear Supplier | Chubbuck, ID |
| 1225391436 | Aime Taylor | Individual | Pharmacist | Chubbuck, ID |
| 1396000121 | Melissa Herzog | Individual | Pharmacist | Chubbuck, ID |
| 1033460647 | Stephen Schiers | Individual | Pharmacist | Chubbuck, ID |
| 1912424375 | Kirsten Blair | Individual | Pharmacist | Chubbuck, ID |
Verify this record
Cross-check NPI 1255378907 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 type of organization is Shopko Stores Operating Co LLC?
What is a Type 2 NPI?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2014-06-06.