Organization
SHOPKO STORES OPERATING CO., LLC
Active
Other names
Shopko Pharmacy #2681
Organization subpart
No
Provider details
NPI number
Authorized official
LORIE NEUMANN (DIR 3RD CONTRACT & CA)
(920) 429-4726
Entity
Organization
Contact information
Practice address
202 SUSAN LAWRENCE DRIVE, IDA GROVE, IA 51445
(712) 364-3198
Mailing address
202 SUSAN LAWRENCE DRIVE, IDA GROVE, IA 51445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
03/31/2016
Last updated
06/24/2016
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