Shopko Stores Operating Co LLC
Shopko Stores Operating Co LLC is a healthcare organization registered as Community/Retail Pharmacy in Beaver Dam, WI, holding Type 2 (organization) NPI 1902852353 since 2006. The authorized official on file is Michael Bettiga, Sr. Vice President Health Services.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1902852353 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Shopko Stores Operating Co LLC |
| Other name | <Unavail> |
| Practice address | 822 PARK AVE, Beaver Dam, WI, 53916 |
| Phone | 9208877461 |
| Fax | 9208870725 |
| Enumeration date | 2006-05-26 |
| 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 | — | — |
| 332H00000X | Eyewear Supplier | Secondary | — | — |
| 3336C0003X | Community/Retail Pharmacy | Primary | 8633042 | WI |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5105247 | Other | — | NCPDP NUMBER |
| 33133600 | Medicaid | WI | — |
Copy-ready billing details
Provider: Shopko Stores Operating Co LLC NPI: 1902852353 Taxonomy: 3336C0003X (Community/Retail Pharmacy) Address: 822 PARK AVE, Beaver Dam, WI, 53916
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1396797411 | Shopko Stores Operating Co. LLC | Organization | Eyewear Supplier | Beaver Dam, WI |
| 1255387684 | Brian Schroedl | Individual | Optometrist | Beaver Dam, WI |
| 1992747745 | Mark James | Individual | Optometrist | Beaver Dam, WI |
| 1902118482 | Michael Dull | Individual | Pharmacist | Beaver Dam, WI |
| 1013353994 | Mike Leahan | Individual | Pharmacist | Beaver Dam, WI |
| 1932547502 | Kevin Wright | Individual | Pharmacist | Beaver Dam, WI |
| 1104264779 | Anthony Bridgeman | Individual | Pharmacist | Beaver Dam, WI |
| 1093198996 | Jessamyn Kovacs | Individual | Optometrist | Beaver Dam, WI |
Verify this record
Cross-check NPI 1902852353 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
How current is this record?
Where is Shopko Stores Operating Co LLC located?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2014-06-06.