Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 083
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSELL STEINHORST (SVP CHIEF FINANCIAL OFFICER)
(920) 429-7489
Entity
Organization
Contact information
Practice address
2165 E 9400 S, SANDY, UT 84093-3201
(801) 942-8555
(801) 943-9121
Mailing address
2165 E 9400 S, SANDY, UT 84093-3201
(801) 942-8555
(801) 943-9121
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1313211703
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
410985054019
—
UT
01
—
4606692
NCPDP NUMBER
—
Enumeration date
05/12/2006
Last updated
08/29/2016
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