Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 069
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSELL STEINHORST (SVP CHIEF FINANCIAL OFFICER)
(920) 429-7489
Entity
Organization
Contact information
Practice address
217 W IRONWOOD DR, COEUR D ALENE, ID 83814-2651
(208) 765-9586
(208) 765-6922
Mailing address
217 W IRONWOOD DR, COEUR D ALENE, ID 83814-2651
(208) 765-9586
(208) 765-6922
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
333600000X
Pharmacy
2037CP
ID
3336C0003X
Community/Retail Pharmacy
Primary
2037CP
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000123100
—
ID
05
—
000123200
—
ID
01
—
0034347
WA LABOR & INDUSTRY
—
01
—
0215806
WA LABOR & INDUSTRY
—
01
—
1304613
NCPDP NUMBER
—
Enumeration date
05/23/2006
Last updated
12/10/2015
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