| NPI | 1649221623 |
|---|---|
| Doing Business As | SHOPKO PHARMACY 104 |
| 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: UT 1323891703) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2008-08-14 |