NPI 1003862442

Shopko Stores Operating Co LLC

Organisation Community/Retail Pharmacy Green Bay, WI

Practice location

Address: 2430 E Mason St, Green Bay, WI 54302-3759
Phone: (920) 468-6044
Fax: (920) 468-3490

Authorised official

Name: Michael J Bettiga
Title: Sr. Vice President Health Services
Phone: (920) 429-4297

Registered specialties (4)

Community/Retail Pharmacy Primary

Suppliers Taxonomy 3336C0003X Licence 8636042 (WI)

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Durable Medical Equipment & Medical Supplies

Suppliers Taxonomy 332B00000X

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Eyewear Supplier

Suppliers Taxonomy 332H00000X

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Pharmacy

Suppliers Taxonomy 333600000X

Registry record

NPI: 1003862442
Entity type: Organization
NPI issued: 26 May 2006
Record last updated: 14 Feb 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.