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Organization
SHOPKO
Active
Organization
SHOPKO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GENA TRAST (PHARMACIST)
(920) 499-5889
Entity
Organization
Contact information
Practice address
301 BAY PARK SQ, GREEN BAY, WI 54304-5104
(920) 499-5889
Mailing address
301 BAY PARK SQ, GREEN BAY, WI 54304-5104
(920) 499-5889
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
051-039854
WI
Other
Enumeration date
10/10/2013
Last updated
10/10/2013
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