# SHOPKO STORES OPERATING CO LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SHOPKO PHARMACY 563
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124473533
- **Authorized official:** LORIE NEUMANN (DIRECTOR OF THIRD PARTY)
- **Authorized official phone:** (920) 429-4726

## Contact information

- **Practice address:** 406 GATEWAY AVE, MAUSTON, WI 53948-1401
- **Practice address phone:** (608) 350-0962
- **Mailing address:** 406 GATEWAY AVE, MAUSTON, WI 53948-1401
- **Mailing address phone:** (608) 350-0962

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 05/04/2016
- **Last updated:** 12/15/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1124473533 | — | WI |