| NPI | 1932153749 |
|---|---|
| Doing Business As | SHOPKO PHARMACY 114 |
| 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: MN 2628082) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 332H00000X Eyewear Supplier | |
| 333600000X Pharmacy | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2013-08-27 |