Shopko Pharmacy 509

LBN: Shopko Stores Operating Co Llc
Shopko Pharmacy 509 is an health care organization with primary practice located at 2820 Roosevelt Rd , Marinette WI 54143. The organization recently has 3 registered licenses in different health care specialties including Suppliers / Durable Medical Equipment & Medical Supplies, Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty. Shopko Stores Operating Co Llc can be contacted via phone (920) 429-4726, or through Paschal, Jannie Delane via phone (920) 429-4726.

Contact Information

Primary practice address
2820 Roosevelt Rd Marinette WI 54143
Phone: (920) 429-4726
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Paschal, Jannie Delane
Phone: (920) 429-4726

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Durable Medical Equipment & Medical Supplies 332B00000X
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X

Profile Details

NPI number 1306397773
LBN Legal business name Shopko Stores Operating Co Llc
DBA Doing business as Shopko Pharmacy 509
Authorized official Paschal, Jannie Delane
Entity Organization
Organization subpart 1 No
Enumeration date Oct 20th, 2016
Last updated Apr 27th, 2018 - about 6 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306397773 NPPES
Wisconsin MEDICAID 1306397773

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