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Organization
SHOPKO STORES OPERATING CO LLC
Active
Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
SHOPKO PHARMACY 793
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BETTIGA RPH (EVP & COO)
(920) 429-4297
Entity
Organization
Contact information
Practice address
2050 HORICON ST, MAYVILLE, WI 53050
(920) 387-0257
Mailing address
2050 HORICON ST, MAYVILLE, WI 53050
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
—
NULL
Other
Enumeration date
04/07/2014
Last updated
04/07/2014
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