Shopko Stores Operating Co. LLC

NPI #1679525729 in Jacksonville, Illinois

Provider Information

NPI Number: 1679525729
Entity Type: Organization
Organization Name: Shopko Stores Operating Co. LLC
Primary Specialty: Eyewear Supplier
Enumeration Date: May 17, 2006
Last Updated: Jun 4, 2008

Practice Location

Address: 1964 W MORTON AVE
City: Jacksonville
State: Illinois
ZIP Code: 62650-2621
Phone: (217) 245-6070

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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