Organization
SHOPKO STORES OPERATING CO LLC
Active
Other names
Shopko Pharmacy 739
Organization subpart
No
Provider details
NPI number
Authorized official
JANNIE DELANE PASCHAL (VP)
(920) 429-4726
Entity
Organization
Contact information
Practice address
710 COUNTY ROAD 21 S, GLENWOOD, MN 56334-9145
(320) 634-4399
(320) 634-4425
Mailing address
710 COUNTY ROAD 21 S, GLENWOOD, MN 56334-9145
(320) 634-4399
(320) 634-4425
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
01
—
2423452
NCPDP
—
05
—
802967900
—
MN
05
—
911938000
—
MN
Enumeration date
05/18/2006
Last updated
04/30/2018
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