Organization
SHOPKO INSTITUTIONAL CARE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL J BETTIGA RPH (EXECUTIVE VICE PRESIDENT AND COO)
(920) 429-4297
Entity
Organization
Contact information
Practice address
700 PILGRIM WAY, GREEN BAY, WI 54304-5263
(920) 429-4218
(920) 429-5218
Mailing address
700 PILGRIM WAY, GREEN BAY, WI 54304-5263
(920) 429-4218
(920) 429-5218
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336L0003X
Long Term Care Pharmacy
Primary
—
—
Other
Enumeration date
11/24/2010
Last updated
12/13/2010
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