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Organization
SHOPKO STORES OPERATING CO LLC
Active
Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
SHOPKO PHARMACY 798
Organization subpart
No
Provider details
NPI number
Authorized official
LORIE NEUMANN (DIRECTOR OF THIRD PARTY)
(920) 429-4726
Entity
Organization
Contact information
Practice address
1635 E HIGHWAY 40, BALLARD, UT 84066-5217
(920) 429-4726
Mailing address
1635 E HIGHWAY 40, BALLARD, UT 84066-5217
(920) 429-4726
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
—
NULL
Other
Enumeration date
08/26/2016
Last updated
08/26/2016
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