Shopko Stores Operating Co. LLC

NPI #1386697092 in Wausau, Wisconsin

Provider Information

NPI Number
1386697092
Entity Type
Organization
Organization Name
Shopko Stores Operating Co. LLC
Primary Specialty
Eyewear Supplier
Enumeration Date
May 17, 2006
Last Updated
Feb 11, 2008

Practice Location

Address
200 S 18TH AVE
City
Wausau
ZIP Code
54401-4252
Phone
(715) 842-8040

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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