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Organization
SHOPKO STORES OPERATING CO LLC
Active
Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 083
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSELL STEINHORST (SVP CHIEF FINANCIAL OFFICER)
(920) 429-7489
Entity
Organization
Contact information
Practice address
2165 E 9400 S, SANDY, UT 84093-3201
(801) 942-8555
(801) 943-9121
Mailing address
2165 E 9400 S, SANDY, UT 84093-3201
(801) 942-8555
(801) 943-9121
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
332H00000X
Eyewear Supplier
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
1313211703
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
410985054019
—
UT
01
—
4606692
NCPDP NUMBER
—
Enumeration date
05/12/2006
Last updated
08/29/2016
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