Shopko Stores Operating Co. LLC
NPI #1619929015 in East Peoria, Illinois
Provider Information
- NPI Number
- 1619929015
- Entity Type
- Organization
- Organization Name
- Shopko Stores Operating Co. LLC
- Primary Specialty
- Eyewear Supplier
- Enumeration Date
- May 16, 2006
- Last Updated
- Sep 28, 2007
Practice Location
- Address
- 105 N MAIN ST
- City
- East Peoria
- State
- Illinois
- ZIP Code
- 61611-2543
- Phone
- (309) 694-6470
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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