| NPI | 1417304544 |
|---|---|
| Doing Business As | SHOPKO PHARMACY 596 |
| Entity Type | Organization |
| Authorized Contact | LORIE NEUMANN Director Of Third Party 920-429-4726 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 333600000X Pharmacy | |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2016-12-01 |