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Organization
SHOPKO INSTITUTIONAL CARE SERVICES CO LLC
Active
Organization
SHOPKO INSTITUTIONAL CARE SERVICES CO LLC
Active
Other names
SHOPKO RXCARE 404
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT AND COO)
(920) 429-4297
Entity
Organization
Contact information
Practice address
150 N PATRICK BLVD, 250, BROOKFIELD, WI 53045-5892
(920) 429-2211
Mailing address
150 N PATRICK BLVD, 250, BROOKFIELD, WI 53045-5892
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
9248-42
WI
Other
Enumeration date
03/17/2014
Last updated
03/17/2014
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