Shopko Institutional Care Services Co LLC

Primary specialty

Long Term Care PharmacyTaxonomy code 3336L0003X

License

9248-42 Issued in WI

Legal business name

SHOPKO INSTITUTIONAL CARE SERVICES CO LLC

Practice address

150 N Patrick Blvd
250
Brookfield, WI 53045-5892

Phone

(920) 429-2211

NPI assigned

Mar 17, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Bettiga, RPH

Title

Executive Vice President and Coo

Phone

(920) 429-4297

Specialties & licenses 2

Addresses

Other names 1

• SHOPKO RXCARE 404 Doing business as

Tax ID family

Shopko Institutional Care Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Shopko Institutional Care Services

  • Long Term Care Pharmacy
  • Green Bay, WI
  • NPI 1992007926
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1395014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395014400000",
    "number": "1831515766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 N PATRICK BLVD",
            "address_2": "250",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530455892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 N PATRICK BLVD",
            "address_2": "250",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530455892",
            "telephone_number": "920-429-2211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPKO INSTITUTIONAL CARE SERVICES CO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-17",
        "last_updated": "2014-03-17",
        "status": "A",
        "authorized_official_last_name": "BETTIGA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT AND COO",
        "authorized_official_telephone_number": "920-429-4297",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "WI",
            "license": "9248-42",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SHOPKO RXCARE 404",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michael W Shefsky, PHD
• Jessica A Sheldon, BCBA
• Devon Shevey
• Zachary Shine, PTA
• Sarah A Shklyar
• Jennifer Showalter, OT
• Denise Jean Showen, OTR
• Kelly Sidhu
• Brandon Siegfried
• Brdget Sierra, APNP

• Long Term Care Pharmacy in Brookfield, WI
• Providers in Brookfield, WI by specialty
• Long Term Care Pharmacy in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.