Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 111
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSELL STEINHORST (SVP CHIEF FINANCIAL OFFICER)
(920) 429-7489
Entity
Organization
Contact information
Practice address
1230 LANCASTER DR SE, SALEM, OR 97317-5800
(503) 371-6830
(503) 371-8159
Mailing address
1230 LANCASTER DR SE, SALEM, OR 97317-5800
(503) 371-6830
(503) 371-8159
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1193
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
038658
—
OR
05
—
278347
—
OR
05
—
278380
—
OR
01
—
3810721
NCPDP NUMBER
—
Enumeration date
05/16/2006
Last updated
04/06/2016
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