Shopko Stores Operating Co LLC
Organization Active NPI Community/Retail Pharmacy · Kiel, WI
NPI 1831477181 · NPPES record last updated Feb 2, 2012
Key facts
- NPI
- 1831477181
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- SHOPKO STORES OPERATING CO LLC
- Practice address
- 1120 State Road 67
Kiel, WI 53042-1630 - Phone
- (920) 429-4243
- NPI assigned
- Aug 3, 2011
- Organization subpart
- No
Authorized official
- Name
- Mr. Michael Bettiga, RPH
- Title
- Executive Vice President & Coo
- Phone
- (920) 429-4297
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Eyewear Supplier | 332H00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
1120 State Road 67
Kiel, WI 53042-1630
Mailing address
1120 State Road 67
Kiel, WI 53042-1630
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831477181 | Medicaid | WI |
Other names
- Shopko Pharmacy 609
Other providers in Kiel, WI
- Deborah Lee Schmidt
- Schubert Family Dental
- Taylor Schubert
- Victor Schueller
- Prachi Shah
- Hannah Smith
- Tesa Le Anne Tapuriah
- Mikealynn M Trimberger-Hendrickson
- Alayna Voitek
- Constance Annie Wallander
All providers in Kiel, WI · Community/Retail Pharmacy in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 2, 2012. 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.