Organization
SHOPKO STORES OPERATING CO., LLC
Active
Other names
Shopko Pharmacy 2214
Organization subpart
No
Provider details
NPI number
Authorized official
LORIE NEUMANN (CONTRACTING AND CRED)
(920) 429-4726
Entity
Organization
Contact information
Practice address
N2934 STATE ROAD 22, WAUTOMA, WI 54982-5267
(920) 429-4726
Mailing address
N2934 STATE ROAD 22, WAUTOMA, WI 54982-5267
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
04/10/2017
Last updated
04/10/2017
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