Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 120
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL J BETTIGA RPH (SR. VICE PRESIDENT HEALTH SERVICES)
(920) 429-4297
Entity
Organization
Contact information
Practice address
405 W 8TH ST, MONROE, WI 53566-1063
(608) 328-3310
(608) 328-3305
Mailing address
405 W 8TH ST, MONROE, WI 53566-1063
(608) 328-3310
(608) 328-3305
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8604042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33197500
—
WI
05
—
410985054120
—
IL
01
—
5121897
NCPDP NUMBER
—
Enumeration date
05/23/2006
Last updated
08/14/2008
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