OrganizationActive
Shopko Stores Operating Co LLC
NPI 1417994161 · Community/Retail Pharmacy · Twin Falls, ID
Provider details
- NPI number
- 1417994161
- Entity type
- Organization
- Primary specialty
- Community/Retail PharmacySuppliers
- Organization subpart
- No
- Authorized official
- Michael Bettiga, Sr. Vice President Health Services(920) 429-4297
Specialties & taxonomies
Suppliers
Suppliers
Suppliers
Profile Score
Detailed profile(91/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
20 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1649 Poleline Rd E
Twin Falls, ID 83301-3592
Phone: (208) 734-3791
Fax: (208) 736-7476
Street-level locationGet directions
Mailing address
1649 Poleline Rd E
Twin Falls, ID 83301-3592
Other names (DBA / former)
- Doing business as
- Shopko Pharmacy 067
Registry dates
- Enumerated
- 2006-06-01
- Last updated
- 2009-07-10
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.