Shopko Pharmacy 612
LBN: Shopko Stores Operating Co Llc
Shopko Pharmacy 612 is an health care organization with primary practice located at 203 N Main St , Lake Mills WI 53551-1610. 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) 648-3455, or through Bettiga, Michael via phone (920) 429-4297.
Contact Information
Primary practice address
203 N Main St
Lake Mills WI 53551-1610
Phone: (920) 648-3455
Fax: (920) 648-2712
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Durable Medical Equipment & Medical Supplies | 332B00000X | ||
| Suppliers / Pharmacy | 333600000X | ||
| Suppliers / Community/Retail Pharmacy | 3336C0003X |
Profile Details
| NPI number | 1407127889 |
|---|---|
| LBN Legal business name | Shopko Stores Operating Co Llc |
| DBA Doing business as | Shopko Pharmacy 612 |
| Authorized official | Bettiga, Michael RPH |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Jan 18th, 2012 |
| Last updated | Apr 20th, 2012 - about 12 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1407127889 | NPPES |
| Wisconsin | MEDICAID | 1407127889 |
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