Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 005
Organization subpart
No
Provider details
NPI number
Authorized official
DILIP SEDANI (VP)
(920) 429-7688
Entity
Organization
Contact information
Practice address
230 N WISCONSIN ST, DE PERE, WI 54115
(920) 336-2323
(920) 336-2186
Mailing address
230 N WISCONSIN ST, DE PERE, WI 54115-2735
(920) 336-2323
(920) 336-2186
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8618042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33058100
—
WI
01
—
5117610
NCPDP NUMBER
—
Enumeration date
05/26/2006
Last updated
08/24/2018
About Stedi
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