Organization
SHOPKO #602
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NICK JACKSON JR. R.PH. (PHARMACY MANAGER)
(920) 834-5251
Entity
Organization
Contact information
Practice address
126 CHARLES ST, OCONTO, WI 54153-9446
(920) 834-5251
(920) 834-9801
Mailing address
126 CHARLES ST, OCONTO, WI 54153-9446
(920) 834-5251
(920) 834-9801
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
900542
WI
Other
Enumeration date
05/20/2013
Last updated
05/20/2013
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