Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 631
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
1800 LAKE SHORE DR E, ASHLAND, WI 54806-2268
(715) 682-8306
(715) 682-4004
Mailing address
1800 LAKE SHORE DR E, ASHLAND, WI 54806-2268
(715) 682-8306
(715) 682-4004
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
01
—
0459230072
MEDICARE ID - TYPE UNSPECIFIED
—
Enumeration date
05/19/2006
Last updated
09/04/2012
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us