Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 2644
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSELL STEINHORST (EVP AND CFO)
(920) 429-7489
Entity
Organization
Contact information
Practice address
11250 N MISSION RD, CLARE, MI 48617-9301
(989) 802-0354
(989) 802-0355
Mailing address
11250 N MISSION RD, CLARE, MI 48617-9301
(989) 802-0354
(989) 802-0355
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301008381
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2364317
NCPDP NUMBER
—
05
—
2364317
—
MI
05
—
4819247
—
MI
05
—
4913427
—
MI
Enumeration date
05/17/2006
Last updated
12/15/2015
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