Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
SHOPKO PHARMACY 793
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BETTIGA RPH (EVP & COO)
(920) 429-4297
Entity
Organization
Contact information
Practice address
2050 HORICON ST, MAYVILLE, WI 53050
(920) 387-0257
Mailing address
2050 HORICON ST, MAYVILLE, WI 53050
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
04/07/2014
Last updated
04/07/2014
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