Shopko Stores Operating Co. LLC
NPI #1629021480 in Fort Madison, Iowa
Provider Information
- NPI Number
- 1629021480
- Entity Type
- Organization
- Organization Name
- Shopko Stores Operating Co. LLC
- Primary Specialty
- Eyewear Supplier
- Enumeration Date
- May 19, 2006
- Last Updated
- Jan 30, 2008
Practice Location
- Address
- 4810 AVENUE O
- City
- Fort Madison
- State
- Iowa
- ZIP Code
- 52627-9677
- Phone
- (319) 372-8633
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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