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Organization
SHOPKO STORES OPERATING CO LLC
Active
Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 005
Organization subpart
No
Provider details
NPI number
Authorized official
DILIP SEDANI (VP)
(920) 429-7688
Entity
Organization
Contact information
Practice address
230 N WISCONSIN ST, DE PERE, WI 54115
(920) 336-2323
(920) 336-2186
Mailing address
230 N WISCONSIN ST, DE PERE, WI 54115-2735
(920) 336-2323
(920) 336-2186
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
8618042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33058100
—
WI
01
—
5117610
NCPDP NUMBER
—
Enumeration date
05/26/2006
Last updated
08/24/2018
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