# SHOPKO STORES OPERATING CO LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ShopKo Pharmacy 132
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780639906
- **Authorized official:** MR. RUSSELL STEINHORST (SVP CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (920) 429-7489

## Contact information

- **Practice address:** 320 S ACCESS RD, RICE LAKE, WI 54868-8572
- **Practice address phone:** (715) 236-7414
- **Practice address fax:** (715) 236-7714
- **Mailing address:** 320 S ACCESS RD, RICE LAKE, WI 54868-8572
- **Mailing address phone:** (715) 236-7414
- **Mailing address fax:** (715) 236-7714

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 332H00000X | Eyewear Supplier | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 8603042 | WI | Yes |

## Other

- **Enumeration date:** 05/24/2006
- **Last updated:** 06/12/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 33203200 | — | WI |
| 01 | — | 5122229 | NCPDP NUMBER | — |