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Organization
SHOPKO STORES OPERATING CO LLC
Active
Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 602
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT AND COO)
(920) 429-4297
Entity
Organization
Contact information
Practice address
126 CHARLES ST, OCONTO, WI 54153-9446
(920) 834-9800
(920) 834-9801
Mailing address
126 CHARLES ST, OCONTO, WI 54153-9446
(920) 834-9800
(920) 834-9801
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
332H00000X
Eyewear Supplier
456-1020161146-03
WI
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
9005-042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1982922860
—
WI
Enumeration date
05/17/2010
Last updated
07/26/2011
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