Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
ShopKo Pharmacy 145
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
1190 N 6TH ST, MONMOUTH, IL 61462-9672
(309) 734-7579
(309) 734-8111
Mailing address
1190 N 6TH ST, MONMOUTH, IL 61462-9672
(309) 734-7579
(309) 734-8111
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332H00000X
Eyewear Supplier
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054015892
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1468695
NCPDP NUMBER
—
05
—
371110040145
—
IL
Enumeration date
06/23/2006
Last updated
12/23/2016
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