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Organization
SHOPKO STORES OPERATING CO LLC
Active
Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 132
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSELL STEINHORST (SVP CHIEF FINANCIAL OFFICER)
(920) 429-7489
Entity
Organization
Contact information
Practice address
320 S ACCESS RD, RICE LAKE, WI 54868-8572
(715) 236-7414
(715) 236-7714
Mailing address
320 S ACCESS RD, RICE LAKE, WI 54868-8572
(715) 236-7414
(715) 236-7714
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
332H00000X
Eyewear Supplier
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
8603042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33203200
—
WI
01
—
5122229
NCPDP NUMBER
—
Enumeration date
05/24/2006
Last updated
06/12/2017
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