# SHOPKO INSTITUTIONAL CARE SERVICES CO LLC

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

## Provider details

- **NPI number:** 1770893968
- **Authorized official:** MR. MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT AND COO)
- **Authorized official phone:** (920) 429-4297

## Contact information

- **Practice address:** 2704 INDUSTRIAL DRIVE, MONONA, WI 53713-4806
- **Practice address phone:** (608) 223-0054
- **Practice address fax:** (608) 223-0225
- **Mailing address:** 2704 INDUSTRIAL DRIVE, MONONA, WI 53713-4806
- **Mailing address phone:** (608) 223-0054
- **Mailing address fax:** (608) 223-0225

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 9042042 | WI | Yes |

## Other

- **Enumeration date:** 10/21/2010
- **Last updated:** 10/17/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1770893968 | — | WI |
| 05 | — | 203940171001 | — | IL |