Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 792
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT AND COO)
(920) 429-7297
Entity
Organization
Contact information
Practice address
79 HOMETOWN DRIVE, TOMAHAWK, WI 54487-9998
(715) 453-5996
Mailing address
79 HOMETOWN DRIVE, TOMAHAWK, WI 54487-9998
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
05
—
1265877435
—
WI
Enumeration date
05/01/2013
Last updated
11/18/2013
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us