Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 132
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
320 S ACCESS RD, RICE LAKE, WI 54868-8572
(715) 236-7414
(715) 236-7714
Mailing address
320 S ACCESS RD, RICE LAKE, WI 54868-8572
(715) 236-7414
(715) 236-7714
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8603042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33203200
—
WI
01
—
5122229
NCPDP NUMBER
—
Enumeration date
05/24/2006
Last updated
06/12/2017
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