Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 170
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LORIE NEUMANN (DIRECTOR 3RD PARTY CONTRACT & CA)
(920) 429-4726
Entity
Organization
Contact information
Practice address
2200 LINCOLN ST, RHINELANDER, WI 54501-3631
(715) 362-3999
(715) 362-4919
Mailing address
2200 LINCOLN ST, RHINELANDER, WI 54501-3631
(715) 362-3999
(715) 362-4919
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8621042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33240900
—
WI
01
—
5125150
NCPDP NUMBER
—
Enumeration date
05/23/2006
Last updated
07/14/2015
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