# SHOPKO STORES OPERATING CO LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ShopKo Pharmacy 145
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912933813
- **Authorized official:** MR. RUSSELL STEINHORST (SVP CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (920) 429-7489

## Contact information

- **Practice address:** 1190 N 6TH ST, MONMOUTH, IL 61462-9672
- **Practice address phone:** (309) 734-7579
- **Practice address fax:** (309) 734-8111
- **Mailing address:** 1190 N 6TH ST, MONMOUTH, IL 61462-9672
- **Mailing address phone:** (309) 734-7579
- **Mailing address fax:** (309) 734-8111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 332H00000X | Eyewear Supplier | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 054015892 | IL | Yes |

## Other

- **Enumeration date:** 06/23/2006
- **Last updated:** 12/23/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1468695 | NCPDP NUMBER | — |
| 05 | — | 371110040145 | — | IL |