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Organization
SHOPKO STORES OPERATING CO LLC
Active
Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
SHOPKO PHARMACY 509
Organization subpart
No
Provider details
NPI number
Authorized official
JANNIE DELANE PASCHAL (VP MANAGED CARE)
(920) 429-4726
Entity
Organization
Contact information
Practice address
2820 ROOSEVELT RD, MARINETTE, WI 54143
(920) 429-4726
Mailing address
2820 ROOSEVELT RD, MARINETTE, WI 54143
(715) 330-6171
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
05
—
1306397773
—
WI
Enumeration date
10/20/2016
Last updated
04/27/2018
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