Organization
SHOPKO STORES OPERATING CO., LLC
Active
Other names
Shopko Pharmacy #2799
Organization subpart
No
Provider details
NPI number
Authorized official
LORIE NEUMANN (DIR 3D PARTY CONTRACT & CA)
(920) 429-4726
Entity
Organization
Contact information
Practice address
440 W MAIN ST, TREMONTON, UT 84337
(920) 429-4726
Mailing address
440 W MAIN ST, TREMONTON, UT 84337
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
—
1366828642
—
UT
Enumeration date
08/10/2015
Last updated
12/23/2015
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