Shopko Stores Operating Co LLC
Pharmacy, Community/Retail Pharmacy in Mauston, WI. Organization (NPI-2).
NPI number1124473533
StatusActive
Last updated in NPPESDec 15, 2016
Details
- NPI
- 1124473533
- Entity type
- Organization (NPI-2)
- Legal business name
- Shopko Stores Operating Co LLC
- Organization subpart
- No
- Enumeration date
- May 4, 2016
- Last updated
- Dec 15, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | – | – | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | – | – | |
| 333600000X | Pharmacy | – | – |
Other names
- Shopko Pharmacy 563 (Doing Business As)
Practice location
406 Gateway AveMauston, WI 53948-1401
Phone 608-350-0962
Mailing address
406 Gateway AveMauston, WI 53948-1401
Phone 608-350-0962
Authorized official
Lorie Neumann
Director Of Third Party
9204294726
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