Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
SHOPKO PHARMACY 716
Organization subpart
No
Provider details
NPI number
Authorized official
LORIE NEUMANN (VP RETAIL HEALTH SERVICES)
(920) 429-4726
Entity
Organization
Contact information
Practice address
1520 W 9TH ST, MOUNT CARMEL, IL 62863-2909
(618) 262-2475
Mailing address
1520 W 9TH ST, MOUNT CARMEL, IL 62863-2909
(618) 262-2475
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
—
P00836438
RAIL ROAD MEDICARE
IL
Enumeration date
04/04/2014
Last updated
09/04/2015
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