| NPI | 1700042884 |
|---|---|
| Doing Business As | SHOPKO PHARMACY 180 |
| Entity Type | Organization |
| Authorized Contact | MICHAEL BETTIGA Sr. Vice President Health Services 920-429-4297 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2008-07-29 |
| Last Update Date | 2009-05-13 |