Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 512
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT & COO)
(920) 429-4297
Entity
Organization
Contact information
Practice address
598 LUCAS LANE, ELLSWORTH, WI 54011
(715) 273-4466
(715) 273-5414
Mailing address
598 LUCAS LANE, ELLSWORTH, WI 54011
(715) 273-4466
(715) 273-5414
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Enumeration date
03/17/2008
Last updated
01/07/2013
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