Organization
SHOPKO STORES OPERATING CO., LLC
Active
Other names
Shopko Pharmacy 795
Organization subpart
No
Provider details
NPI number
Authorized official
LORIE NEUMANN (DIR 3D PARTY CONTRACT & CA)
(920) 429-4726
Entity
Organization
Contact information
Practice address
1026 S CHALLIS ST, SALMON, ID 83467-5441
(208) 742-1285
(208) 742-1283
Mailing address
1026 S CHALLIS ST, SALMON, ID 83467-5441
(208) 742-1285
(208) 742-1283
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912398736
—
ID
Enumeration date
02/16/2015
Last updated
07/07/2015
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