# SHOPKO INSTITUTIONAL CARE SERVICES CO LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SHOPKO RXCARE 404
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831515766
- **Authorized official:** MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT AND COO)
- **Authorized official phone:** (920) 429-4297

## Contact information

- **Practice address:** 150 N PATRICK BLVD, 250, BROOKFIELD, WI 53045-5892
- **Practice address phone:** (920) 429-2211
- **Mailing address:** 150 N PATRICK BLVD, 250, BROOKFIELD, WI 53045-5892

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | 9248-42 | WI | Yes |

## Other

- **Enumeration date:** 03/17/2014
- **Last updated:** 03/17/2014