Shopko Stores Operating Co LLC

NPI #1477831618 in Seymour, Wisconsin

Provider Information

NPI Number
1477831618
Entity Type
Organization
Organization Name
Shopko Stores Operating Co LLC
Primary Specialty
Eyewear Supplier
Enumeration Date
Jul 21, 2011
Last Updated
Oct 17, 2011

Practice Location

Address
1010 SOUTH MAINLINE DR
ZIP Code
54165-1451
Phone
(920) 833-0430

Authorized Official

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

Specialties & Taxonomy Codes

Specialty
Eyewear Supplier

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