| NPI | 1518905991 |
|---|---|
| Doing Business As | SHOPKO PHARMACY 712 |
| Entity Type | Organization |
| Authorized Contact | MICHAEL BETTIGA Excutive Vice President & COO 920-429-7297 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 333600000X Pharmacy | |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2012-07-31 |