| NPI | 1255378907 |
|---|---|
| Doing Business As | SHOPKO PHARMACY 063 |
| Entity Type | Organization |
| Authorized Contact | MICHAEL J BETTIGA Sr. Vice President Health Services 920-429-4297 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: ID 2039CP) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 332H00000X Eyewear Supplier | |
| 333600000X Pharmacy (Licence: ID 2039CP) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2014-06-06 |