| NPI | 1124072921 |
|---|---|
| Doing Business As | SHOPKO PHARMACY 112 |
| Entity Type | Organization |
| Authorized Contact | DILIP SEDANI VP Managed Health Care 920-429-7688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MT 1197) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2018-07-25 |