Organization
SHOPKO STORES OPERATING CO LLC
Active
Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 038
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
2208 N WEBB RD, GRAND ISLAND, NE 68803-1739
(308) 382-6744
(308) 381-8401
Mailing address
2208 N WEBB RD, GRAND ISLAND, NE 68803-1739
(308) 382-6744
(308) 381-8401
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2676
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025074300
—
NE
05
—
10025413600
—
NE
01
—
2811138
NCPDP NUMBER
—
Enumeration date
05/12/2006
Last updated
12/21/2015
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