# SHOPKO STORES OPERATING CO., LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Shopko Pharmacy \#2799
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366828642
- **Authorized official:** LORIE NEUMANN (DIR 3D PARTY CONTRACT & CA)
- **Authorized official phone:** (920) 429-4726

## Contact information

- **Practice address:** 440 W MAIN ST, TREMONTON, UT 84337
- **Practice address phone:** (920) 429-4726
- **Mailing address:** 440 W MAIN ST, TREMONTON, UT 84337

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 08/10/2015
- **Last updated:** 12/23/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1366828642 | — | UT |