Organization
SHOPKO STORES OPERATING CO LLC
Active
Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 2646
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSELL STEINHORST (SVP AND COO)
(920) 429-7489
Entity
Organization
Contact information
Practice address
3825 S HURON RD, STANDISH, MI 48658-9474
(989) 846-0749
(989) 846-0079
Mailing address
3825 S HURON RD, STANDISH, MI 48658-9474
(989) 846-0749
(989) 846-0079
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
—
2352994
NCPDP NUMBER
—
05
—
2352994
—
MI
05
—
3082654
—
MI
05
—
3082663
—
MI
05
—
4913848
—
MI
Enumeration date
05/17/2006
Last updated
12/14/2015
Update your record
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