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Organization
SHOPKO STORES OPERATING CO LLC
Active
Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Express Pharmacy 502
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL J BETTIGA RPH (SR. VICE PRESIDENT HEALTH SERVICES)
(920) 429-4297
Entity
Organization
Contact information
Practice address
2585 LINEVILLE RD, GREEN BAY, WI 54313-7122
(920) 662-9450
(920) 662-1912
Mailing address
2585 LINEVILLE RD, GREEN BAY, WI 54313-7122
(920) 662-9450
(920) 662-1912
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
8597042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33279000
—
WI
01
—
5128168
NCPDP NUMBER
—
Enumeration date
05/24/2006
Last updated
05/22/2014
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