Shopko Stores Operating Co. LLC

NPI #1811949803 in Freeport, Illinois

Provider Information

NPI Number: 1811949803
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: 555 W SOUTH ST
City: Freeport
State: Illinois
ZIP Code: 61032-6792
Phone: (815) 232-3057

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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