Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 609
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BETTIGA RPH (EXECUTIVE VICE PRESIDENT & COO)
(920) 429-4297
Entity
Organization
Contact information
Practice address
1120 STATE ROAD 67, KIEL, WI 53042-1630
(920) 429-4243
Mailing address
1120 STATE ROAD 67, KIEL, WI 53042-1630
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1831477181
—
WI
Enumeration date
08/03/2011
Last updated
02/02/2012
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