# SHOPKO STORES OPERATING CO LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Shopko Pharmacy 790
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578811675
- **Authorized official:** MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT & COO)
- **Authorized official phone:** (920) 429-4297

## Contact information

- **Practice address:** 409 JUNCTION AVE, STANLEY, WI 54768-8011
- **Practice address phone:** (715) 644-6168
- **Practice address fax:** (715) 644-5956
- **Mailing address:** 409 JUNCTION AVE, STANLEY, WI 54768-8011

## 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:** 08/21/2012
- **Last updated:** 01/25/2013