Shopko Stores Operating Co Llc is a health care provider in Syracuse, IN. In this page you will find its mailing address, practice location, phone number, specialty etc.
|Practice Location||1101 N Indiana Ave, Syracuse, IN 46567-1019, US|
|Practice Location Phone||574-457-3109|
|Practice Location Fax||574-457-3186|
|Legal Business Name||SHOPKO STORES OPERATING CO LLC|
|Other Organization Name||SHOPKO PHARMACY 647|
|Other Organization Name Type||Doing Business As Name|
|Enumeration Date ?||Jul 1, 2006|
|Last Update Date ?||Oct 15, 2012|
NPI: National Provider Identifier issued to health care providers by Centers for Medicare and Medicaid Services (CMS).
|Specialty||Provider Type||Specialization||License||License State|
|Durable Medical Equipment & Medical Supplies||Suppliers|
|Provider Id||Issuer State||Issuer Type||Issuer|
|0459230115||Medicare Id-type Unspecified|
An authorized official is an appointed official with the legal authority to make changes and/or updates to the Shopko Stores Operating Co Llc's status and to commit the provider to fully abide by the laws and regulations relating to the National Provider Identifier (NPI).
|Authorized Official||Mr. Michael Bettiga (RPH)|
|Authorized Official Title/Position||EXECUTIVE VICE PRESIDENT & COO|
|Authorized Official Phone Number||920-429-4297|