Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
SHOPKO PHARMACY 563
Organization subpart
No
Provider details
NPI number
Authorized official
LORIE NEUMANN (DIRECTOR OF THIRD PARTY)
(920) 429-4726
Entity
Organization
Contact information
Practice address
406 GATEWAY AVE, MAUSTON, WI 53948-1401
(608) 350-0962
Mailing address
406 GATEWAY AVE, MAUSTON, WI 53948-1401
(608) 350-0962
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
—
1124473533
—
WI
Enumeration date
05/04/2016
Last updated
12/15/2016
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