Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 505
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL BETTIGA RPH (SR. VICE PRESIDENT HEALTH SERVICES)
(920) 429-4297
Entity
Organization
Contact information
Practice address
2101 E EVERGREEN DR, APPLETON, WI 54913-9001
(920) 111-1111
Mailing address
2101 E EVERGREEN DR, APPLETON, WI 54913-9001
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36227100
—
WI
Enumeration date
11/28/2007
Last updated
07/25/2008
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