Shopko Pharmacy 015

LBN: Shopko Stores Operating Co Llc
Shopko Pharmacy 015 is an health care organization with primary practice located at 1000 W Northland Ave , Appleton WI 54914-1419. 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) 739-6871, or through Bettiga, Michael J via phone (920) 429-4297.

Contact Information

Primary practice address
1000 W Northland Ave Appleton WI 54914-1419
Phone: (920) 739-6871
Fax: (920) 731-6167
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 8592042 Wisconsin

Profile Details

NPI number 1811943269
LBN Legal business name Shopko Stores Operating Co Llc
DBA Doing business as Shopko Pharmacy 015
Authorized official Bettiga, Michael J RPH
Entity Organization
Organization subpart 1 No
Enumeration date May 26th, 2006
Last updated Jan 21st, 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 1811943269 NPPES
Other 5111290 NCPDP NUMBER
MEDICAID 33129400 NCPDP NUMBER

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