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Organization
SHOPKO STORES OPERATING CO LLC
Active
Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
SHOPKO PHARMACY 716
Organization subpart
No
Provider details
NPI number
Authorized official
LORIE NEUMANN (VP RETAIL HEALTH SERVICES)
(920) 429-4726
Entity
Organization
Contact information
Practice address
1520 W 9TH ST, MOUNT CARMEL, IL 62863-2909
(618) 262-2475
Mailing address
1520 W 9TH ST, MOUNT CARMEL, IL 62863-2909
(618) 262-2475
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00836438
RAIL ROAD MEDICARE
IL
Enumeration date
04/04/2014
Last updated
09/04/2015
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