NPI age
20 years
Enumerated 2006-05-23
● Active Type 2 · Organization
Shopko Stores Operating Co Llc
Shopko Stores Operating Co Llc is 1 of 397 pharmacy organizations in Idaho.
Primary specialty
Pharmacy
Plus 3 secondary
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Bettiga
SR. Vice President Health Services
Last NPPES update
2014-07-25
Source: monthly bulk 2026-05
How this organization compares
Across 397 active pharmacy providers in Idaho.
NPI age
20 years
≈ at median (19 yr)
Practice locations
1
0 secondary on file
Subspecialties
3
In the 70% of peers with subspecialties
NPI lifetime · 2006 → 2026
2006-05Enumerated in NPPES
2006
2026
Where they practice
Primary practice location
2100 Caldwell Blvd
Nampa, ID 836511510
Mailing address
2100 Caldwell Blvd
Nampa, ID 836511510
Authorized official
Michael J Bettiga, RPH
SR. Vice President Health Services
📞 9204294297
Individual providers at this organization
4 individual providers on file at this primary practice address.
- Joy Johnson, O.D. Optometrist NPI 1659324960
- Mark McKell, O.D. Optometrist NPI 1396853974
- Thomas Statz Pharmacist NPI 1699022962
- Timothy Swain, RPH, PHARM D Pharmacist NPI 1346597606
Specialties
-
Pharmacy PrimaryA pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the...
-
Durable Medical Equipment & Medical SuppliesA supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.
-
Eyewear SupplierAn organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.
-
PharmacyA facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 000311800 | |
| 01 | 0215801 | WA LABOR & INDUSTRY |
| 01 | 0193994 | WA LABOR & INDUSTRY |
| 01 | 1304524 | NCPDP NUMBER |
Other names on file (1)
Doing-business-as, former, and alternate names recorded by NPPES.
-
ShopKo Pharmacy 064
Practice context
Multi-provider organization. 4 individual providers on file at this primary address.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Verify the organization is in good standing.Cross-check with the state's business registration and any applicable licensing boards.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.