Organization
SHOPKO STORES OPERATING CO., LLC
Active
Other names
Shopko Pharmacy 2215
Organization subpart
No
Provider details
NPI number
Authorized official
JANNIE DELANE PASCHAL (VP MANAGED CARE)
(920) 429-4726
Entity
Organization
Contact information
Practice address
100 COUNTY ROAD B, SHAWANO, WI 54166-7072
(920) 429-4726
Mailing address
100 COUNTY ROAD B STE W181, SHAWANO, WI 54166-7072
(715) 526-3456
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003349101
—
WI
Enumeration date
04/05/2017
Last updated
04/27/2018
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