Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 2606
Organization subpart
No
Provider details
NPI number
Authorized official
RUSSELL STEINHORST (SVP AND CFO)
(920) 429-7489
Entity
Organization
Contact information
Practice address
56835 NORTH STATION DR, CALUMET, MI 49913-2903
(906) 337-2698
(906) 337-3695
Mailing address
56835 NORTH STATION DR, CALUMET, MI 49913-2903
(906) 337-2698
(906) 337-3695
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
—
2375461
—
MI
Enumeration date
03/17/2011
Last updated
12/15/2015
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