Shopko Stores Operating Co. LLC

NPI #1073565180 in Peoria, Illinois

Provider Information

NPI Number
1073565180
Entity Type
Organization
Organization Name
Shopko Stores Operating Co. LLC
Primary Specialty
Eyewear Supplier
Enumeration Date
May 17, 2006
Last Updated
Sep 28, 2007

Practice Location

Address
2323 W PIONEER PKWY
City
Peoria
ZIP Code
61615-1833
Phone
(309) 691-4815

Authorized Official

Name
MICHAEL J BETTIGA, RPH
Title
SR. VICE PRESIDENT HEALTH SERVICES
Phone
(920) 429-4297

Specialties & Taxonomy Codes

Specialty
Eyewear Supplier

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