Shopko Stores Operating Co. LLC

NPI #1457304024 in Fairmont, Minnesota

Provider Information

NPI Number: 1457304024
Entity Type: Organization
Organization Name: Shopko Stores Operating Co. LLC
Primary Specialty: Eyewear Supplier
Enumeration Date: May 18, 2006
Last Updated: Apr 15, 2008

Practice Location

Address: 1001 HIGHWAY 15 S
City: Fairmont
State: Minnesota
ZIP Code: 56031-4456
Phone: (507) 238-9490

Authorized Official

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

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Eyewear Supplier	332H00000X	Primary

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