# SHOPKO

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184051948
- **Authorized official:** GENA TRAST (PHARMACIST)
- **Authorized official phone:** (920) 499-5889

## Contact information

- **Practice address:** 301 BAY PARK SQ, GREEN BAY, WI 54304-5104
- **Practice address phone:** (920) 499-5889
- **Mailing address:** 301 BAY PARK SQ, GREEN BAY, WI 54304-5104
- **Mailing address phone:** (920) 499-5889

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 051-039854 | WI | Yes |

## Other

- **Enumeration date:** 10/10/2013
- **Last updated:** 10/10/2013