# SHOPKO INSTITUTIONAL CARE SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992007926
- **Authorized official:** MR. MICHAEL J BETTIGA RPH (EXECUTIVE VICE PRESIDENT AND COO)
- **Authorized official phone:** (920) 429-4297

## Contact information

- **Practice address:** 700 PILGRIM WAY, GREEN BAY, WI 54304-5263
- **Practice address phone:** (920) 429-4218
- **Practice address fax:** (920) 429-5218
- **Mailing address:** 700 PILGRIM WAY, GREEN BAY, WI 54304-5263
- **Mailing address phone:** (920) 429-4218
- **Mailing address fax:** (920) 429-5218

## Taxonomy

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

## Other

- **Enumeration date:** 11/24/2010
- **Last updated:** 12/13/2010