Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 2016
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSELL STEINHORST (SVP AND CFO)
(920) 429-7489
Entity
Organization
Contact information
Practice address
2530 1ST AVE N, ESCANABA, MI 49829-1390
(906) 786-2011
(906) 786-2816
Mailing address
2530 1ST AVE N, ESCANABA, MI 49829-1390
(906) 786-2011
(906) 786-2816
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301008360
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2341763
NCPDP #
—
05
—
2341763
—
MI
01
—
4819040
MI MEDICAID DME
—
01
—
4913383
MI MEDICAID DME
—
01
—
9000B11041
BLUE CROSS PIN
MI
Enumeration date
05/12/2006
Last updated
12/14/2015
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us