Shopko Stores Operating Co.,llc

NPI #1952642589 in Waupaca, Wisconsin

Provider Information

NPI Number: 1952642589
Entity Type: Organization
Organization Name: Shopko Stores Operating Co.,llc
Primary Specialty: Eyewear Supplier
Enumeration Date: Mar 6, 2013
Last Updated: Mar 6, 2013

Practice Location

Address: 825 W FULTON ST
City: Waupaca
State: Wisconsin
ZIP Code: 54981-1471
Phone: (715) 258-9000

Authorized Official

Name: MICHAEL BETTIGA, RPH
Title: EXECUTIVE VICE PRESIDENT AND COO
Phone: 92042949297

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Eyewear Supplier	332H00000X	Primary

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