Organization
SHOPKO INSTITUTIONAL CARE SERVICES CO LLC
Active
Other names
Shopko RxCare
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
3701 E EVERGREEN DR, STE 1000, APPLETON, WI 54913-7402
(920) 739-7855
(920) 739-3922
Mailing address
3701 E EVERGREEN DR, STE 1000, APPLETON, WI 54913-7402
(920) 739-7855
(920) 739-3922
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336L0003X
Long Term Care Pharmacy
Primary
9041042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053621243
—
MI
05
—
1053621243
—
WI
Enumeration date
10/21/2010
Last updated
11/01/2011
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