# SHOPKO STORES OPERATING CO LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ShopKo Pharmacy 170
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871548594
- **Authorized official:** MS. LORIE NEUMANN (DIRECTOR 3RD PARTY CONTRACT & CA)
- **Authorized official phone:** (920) 429-4726

## Contact information

- **Practice address:** 2200 LINCOLN ST, RHINELANDER, WI 54501-3631
- **Practice address phone:** (715) 362-3999
- **Practice address fax:** (715) 362-4919
- **Mailing address:** 2200 LINCOLN ST, RHINELANDER, WI 54501-3631
- **Mailing address phone:** (715) 362-3999
- **Mailing address fax:** (715) 362-4919

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 332H00000X | Eyewear Supplier | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 8621042 | WI | Yes |

## Other

- **Enumeration date:** 05/23/2006
- **Last updated:** 07/14/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 33240900 | — | WI |
| 01 | — | 5125150 | NCPDP NUMBER | — |