Shopko Stores Operating Co LLC
Pharmacy, Community/Retail Pharmacy in Kewaunee, WI. Organization (NPI-2).
NPI number1891014635
StatusActive
Last updated in NPPESSep 22, 2010
Details
- NPI
- 1891014635
- Entity type
- Organization (NPI-2)
- Legal business name
- Shopko Stores Operating Co LLC
- Organization subpart
- No
- Enumeration date
- May 19, 2010
- Last updated
- Sep 22, 2010
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | 9006-042 | WI | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | – | – | |
| 333600000X | Pharmacy | – | – |
Other names
- Shopko Pharmacy 601 (Doing Business As)
Practice location
802 N Main StKewaunee, WI 54216-0274
Phone 920-388-2231 · Fax 920-388-2459
Mailing address
802 N Main StPo Box 274
Kewaunee, WI 54216-0274
Phone 920-388-2231 · Fax 920-388-2459
Authorized official
Michael Bettiga
Executive Vice President And Coo
9204294297
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