Shopko Stores Operating Co LLC

NPI #1356684245 in Glencoe, Minnesota

Provider Information

NPI Number: 1356684245
Entity Type: Organization
Organization Name: Shopko Stores Operating Co LLC
Primary Specialty: Eyewear Supplier
Enumeration Date: Mar 29, 2013
Last Updated: Mar 29, 2013

Practice Location

Address: 3225 10TH ST E
City: Glencoe
State: Minnesota
ZIP Code: 55336-3369
Phone: (320) 864-5194

Authorized Official

Name: MICHAEL BETTIGA, RPH
Title: EXECUTIVE VICE PRESIDENT AND COO
Phone: (920) 429-4297

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Eyewear Supplier	332H00000X	Primary

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