Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Shopko Stores Operating Co LLC

Organization Durable Medical Equipment & Medical Supplies · NPI 1417994161

Shopko Stores Operating Co LLC is a Durable Medical Equipment & Medical Supplies in Twin Falls, Idaho. Licensed in Idaho. Registered with an NPI since 2006.

Licensed in
ID
In the registry since
2006
Specialties on file
3
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1649 Poleline Rd E
Twin Falls, ID 83301-3592
Phone: (208) 734-3791
Fax: (208) 736-7476
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Community/Retail Pharmacy (primary) Taxonomy 3336C0003X · Licence 2043CP (ID)
Durable Medical Equipment & Medical Supplies Taxonomy 332B00000X
Pharmacy Taxonomy 333600000X · Licence 2043CP (ID)

Record details

NPI number1417994161
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Michael Bettiga — Sr. Vice President Health Services · (920) 429-4297
Other names Shopko Pharmacy 067
NPI enumeratedJune 1, 2006
Last updated in NPPESJuly 10, 2009
Mailing address1649 Poleline Rd E, Twin Falls, ID 83301-3592

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