Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 633
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT & COO)
(920) 429-4297
Entity
Organization
Contact information
Practice address
1333 4TH AVE S, PARK FALLS, WI 54552-1926
(715) 762-4764
(715) 762-4934
Mailing address
1333 4TH AVE S, PARK FALLS, WI 54552-1926
(715) 762-4764
(715) 762-4934
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
05/19/2006
Last updated
08/24/2012
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