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Contact Information

SHOPKO STORES OPERATING CO LLC
N 66 W 25201
CTH V V
SUSSEX, WI53089
 Phone: 262-820-2611
 Fax: 262-820-2592
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Community/Retail Pharmacy

3336C0003X 58 Medical Supply Company with Pharmacist
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
 

Eyewear Supplier

332H00000X 87 All Other Suppliers
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for SHOPKO STORES OPERATING CO LLC

NPI Number 1982865945
LBN Legal business name SHOPKO STORES OPERATING CO LLC
Authorized official MICHAEL BETTIGA - (SR VICE PRESIDENT HEALTH SERVICES)
Entity Organization
Organization subpart 1 No
Enumeration date 06/23/2008
Last updated 07/25/2014 - About 12 years ago
Identifiers
WI Medicaid 36229200
Other 488000297 MEDCO
Other 5131014 NCPDP #
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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