Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 2621
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSELL STEINHORST (SVP AND COO)
(920) 429-7489
Entity
Organization
Contact information
Practice address
717 E LAKESHORE DR, MANISTIQUE, MI 49854-1682
(906) 341-3994
(906) 341-3996
Mailing address
717 E LAKESHORE DR, MANISTIQUE, MI 49854-1682
(906) 341-3994
(906) 341-3996
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
—
0459230120
MEDICARE ID - TYPE UNSPECIFIED
—
Enumeration date
05/18/2006
Last updated
12/15/2015
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