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Organization

SHOPKO INSTITUTIONAL CARE SERVICES CO LLC

Active
Other names
Shopko RxCare
Organization subpart
No

Provider details

NPI number
Authorized official
MR. MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT AND COO)
(920) 429-4297
Entity
Organization

Contact information

Practice address
2704 INDUSTRIAL DRIVE, MONONA, WI 53713-4806
(608) 223-0054
(608) 223-0225
Mailing address
2704 INDUSTRIAL DRIVE, MONONA, WI 53713-4806
(608) 223-0054
(608) 223-0225

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
3336L0003X
Long Term Care Pharmacy
Primary
9042042
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1770893968
WI
05
203940171001
IL
Enumeration date
10/21/2010
Last updated
10/17/2013
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