| NPI | 1538195300 |
|---|---|
| Doing Business As | SHOPKO PHARMACY 174 |
| Entity Type | Organization |
| Authorized Contact | MICHAEL J BETTIGA Sr. Vice President Health Services 920-429-4297 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2020-08-22 |