Shopko #602
Organization Active NPI Pharmacy · Oconto, WI
NPI 1265878110 · NPPES record last updated May 20, 2013
Key facts
- NPI
- 1265878110
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- 900542 (WI)
- Legal business name
- SHOPKO #602
- Practice address
- 126 Charles St
Oconto, WI 54153-9446 - Phone
- (920) 834-5251
- Fax
- (920) 834-9801
- NPI assigned
- May 20, 2013
- Organization subpart
- No
Authorized official
- Name
- Mr. Nick Jackson Jr., R.PH.
- Title
- Pharmacy Manager
- Phone
- (920) 834-5251
Corporate family (same tax ID) 15
National Provider Directory
- Tax ID family
- Shopko Stores Operat Co LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | 900542 | WI | Yes |
Addresses
Primary practice location
126 Charles St
Oconto, WI 54153-9446
Mailing address
126 Charles St
Oconto, WI 54153-9446
Phone (920) 834-5251
Other providers in Oconto, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 20, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.