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Organization
SHOPKO STORES OPERATING CO LLC
Active
Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 604
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT AND COO)
(920) 429-4297
Entity
Organization
Contact information
Practice address
1011 E SPRUCE ST, ABBOTSFORD, WI 54405-9647
(715) 223-2480
(715) 223-2663
Mailing address
1011 E SPRUCE ST, ABBOTSFORD, WI 54405-9647
(715) 223-2480
(715) 223-2663
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
9064-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144529058
—
WI
Enumeration date
03/17/2011
Last updated
05/31/2011
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