Shopko Stores Operating Co LLC
NPI #1902852353 in Beaver Dam, Wisconsin
Provider Information
- NPI Number
- 1902852353
- Entity Type
- Organization
- Organization Name
- Shopko Stores Operating Co LLC
- Primary Specialty
- Pharmacy - Community/Retail Pharmacy
- Enumeration Date
- May 26, 2006
- Last Updated
- Jun 6, 2014
Practice Location
- Address
- 822 PARK AVE
- City
- Beaver Dam
- State
- Wisconsin
- ZIP Code
- 53916-2266
- Phone
- (920) 887-7461
Authorized Official
- Name
- MR. MICHAEL J BETTIGA, RPH
- Title
- SR. VICE PRESIDENT HEALTH SERVICES
- Phone
- (920) 429-4297
Specialties & Taxonomy Codes
| Specialty |
|---|
| Durable Medical Equipment & Medical Supplies |
| Pharmacy |
| Eyewear Supplier |
| Pharmacy - Community/Retail Pharmacy — Community/Retail Pharmacy |
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