Shopko Stores Operating Co LLC

NPI #1114100518 in Appleton, Wisconsin

Provider Information

NPI Number
1114100518
Entity Type
Organization
Organization Name
Shopko Stores Operating Co LLC
Primary Specialty
Eyewear Supplier
Enumeration Date
Dec 10, 2007
Last Updated
Jul 17, 2008

Practice Location

Address
W3208 VAN ROY RD
ZIP Code
54915
Phone
(920) 111-1111

Authorized Official

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

Specialties & Taxonomy Codes

Specialty
Eyewear Supplier

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