# SHOPKO STORES OPERATING CO LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SHOPKO PHARMACY \#2205
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740736586
- **Authorized official:** LORIE NEUMANN (DIRECTOR OF THIRD PARTY)
- **Authorized official phone:** 92044294726

## Contact information

- **Practice address:** 94 NORTH 400 EAST, DELTA, UT 84624
- **Practice address phone:** (920) 429-4726
- **Mailing address:** 94 NORTH 400 EAST, DELTA, UT 84624
- **Mailing address phone:** (920) 429-4726

## 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:** 08/31/2016
- **Last updated:** 11/15/2016