Shopko Pharmacy 504

LBN: Shopko Stores Operating Co Llc
Shopko Pharmacy 504 is an health care organization with primary practice located at W3208 Van Roy Rd , Appleton WI 54915. 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) 111-1111, or through Bettiga, Michael via phone (920) 429-4297.

Contact Information

Primary practice address
W3208 Van Roy Rd Appleton WI 54915
Phone: (920) 111-1111
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Bettiga, Michael RPH
Phone: (920) 429-4297

Health care specialties

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

Profile Details

NPI number 1760665160
LBN Legal business name Shopko Stores Operating Co Llc
DBA Doing business as Shopko Pharmacy 504
Authorized official Bettiga, Michael RPH
Entity Organization
Organization subpart 1 No
Enumeration date Dec 10th, 2007
Last updated Aug 15th, 2008 - about 16 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 1760665160 NPPES
Wisconsin MEDICAID 36227000

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