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Organization
SHOPKO INSTITUTIONAL CARE SERVICES CO LLC
Active
Organization
SHOPKO INSTITUTIONAL CARE SERVICES CO LLC
Active
Other names
Shopko RxCare
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT AND COO)
(920) 429-4297
Entity
Organization
Contact information
Practice address
3184 LONDON RD, EAU CLAIRE, WI 54701-6834
(715) 832-3780
(715) 832-3766
Mailing address
3184 LONDON RD, EAU CLAIRE, WI 54701-6834
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1811235781
—
WI
01
—
5133513
NCPDP
WI
01
—
9191-42
LICENSE
—
Enumeration date
01/28/2013
Last updated
03/07/2023
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