# SHOPKO INSTITUTIONAL CARE SERVICES CO LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Shopko RxCare
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053621243
- **Authorized official:** MR. MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT AND COO)
- **Authorized official phone:** (920) 429-4297

## Contact information

- **Practice address:** 3701 E EVERGREEN DR, STE 1000, APPLETON, WI 54913-7402
- **Practice address phone:** (920) 739-7855
- **Practice address fax:** (920) 739-3922
- **Mailing address:** 3701 E EVERGREEN DR, STE 1000, APPLETON, WI 54913-7402
- **Mailing address phone:** (920) 739-7855
- **Mailing address fax:** (920) 739-3922

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 9041042 | WI | Yes |

## Other

- **Enumeration date:** 10/21/2010
- **Last updated:** 11/01/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1053621243 | — | MI |
| 05 | — | 1053621243 | — | WI |