# 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:** 1811235781
- **Authorized official:** MR. MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT AND COO)
- **Authorized official phone:** (920) 429-4297

## Contact information

- **Practice address:** 3184 LONDON RD, EAU CLAIRE, WI 54701-6834
- **Practice address phone:** (715) 832-3780
- **Practice address fax:** (715) 832-3766
- **Mailing address:** 3184 LONDON RD, EAU CLAIRE, WI 54701-6834

## Taxonomy

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

## Other

- **Enumeration date:** 01/28/2013
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1811235781 | — | WI |
| 01 | — | 5133513 | NCPDP | WI |
| 01 | — | 9191-42 | LICENSE | — |