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

Shopko Stores Operating Co LLC

Organization Durable Medical Equipment & Medical Supplies · NPI 1972539740

Shopko Stores Operating Co LLC is a Durable Medical Equipment & Medical Supplies in East Peoria, Illinois. Licensed in Illinois. Registered with an NPI since 2006.

Licensed in
IL
In the registry since
2006
Specialties on file
2
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

105 N Main St
East Peoria, IL 61611-2543
Phone: (309) 699-0632
Fax: (309) 694-6426
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Durable Medical Equipment & Medical Supplies (primary) Taxonomy 332B00000X
Community/Retail Pharmacy Taxonomy 3336C0003X (IL)

Record details

NPI number1972539740
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Michael Bettiga — Sr. Vice President Health Services · (920) 429-4297
Other names Shopko Pharmacy 173
NPI enumeratedJune 24, 2006
Last updated in NPPESSeptember 11, 2025
Mailing address105 N Main St, East Peoria, IL 61611-2543

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