Shopko Pharmacy 033

LBN: Shopko Stores Operating Co Llc
Shopko Pharmacy 033 is an health care organization with primary practice located at 1578 Appleton Rd , Menasha WI 54952-1104. The organization recently has 4 registered licenses in different health care specialties including Suppliers / Durable Medical Equipment & Medical Supplies, Suppliers / Eyewear Supplier (Equipment, not the service), 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) 722-1895, or through Bettiga, Michael J via phone (920) 429-4297.

Contact Information

Primary practice address
1578 Appleton Rd Menasha WI 54952-1104
Phone: (920) 722-1895
Fax: (920) 722-3195
Website:
Map and Directions
Authorized official contact:
Name: Bettiga, Michael J RPH
Phone: (920) 429-4297

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Durable Medical Equipment & Medical Supplies 332B00000X
Suppliers / Eyewear Supplier (Equipment, not the service) 332H00000X
Suppliers / Pharmacy 333600000X
Suppliers / Community/Retail Pharmacy 3336C0003X 8628042 Wisconsin

Profile Details

NPI number 1508812959
LBN Legal business name Shopko Stores Operating Co Llc
DBA Doing business as Shopko Pharmacy 033
Authorized official Bettiga, Michael J RPH
Entity Organization
Organization subpart 1 No
Enumeration date May 26th, 2006
Last updated Apr 16th, 2014 - about 11 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 1508812959 NPPES
Wisconsin MEDICAID 33031600
Wisconsin Other 5115779

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