Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 2650
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSELL STEINHORST (SVP AND COO)
(920) 429-7489
Entity
Organization
Contact information
Practice address
56419 POKAGON ST, DOWAGIAC, MI 49047-7721
(269) 782-0280
(269) 782-0282
Mailing address
56419 POKAGON ST, DOWAGIAC, MI 49047-7721
(269) 782-0280
(269) 782-0282
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
01
—
2367096
NCPDP NUMBER
—
05
—
2367096
—
MI
05
—
4819274
—
MI
05
—
4913436
—
MI
05
—
540A410170
—
SC
Enumeration date
05/17/2006
Last updated
12/15/2015
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