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Shopko Stores Operating Co Llc

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.

physician-icon Basic Information

Practice Location 1101 N Indiana Ave, Syracuse, IN 46567-1019, US
Practice Location Phone574-457-3109
Practice Location Fax574-457-3186
Legal Business NameSHOPKO STORES OPERATING CO LLC
Other Organization NameSHOPKO PHARMACY 647
Other Organization Name TypeDoing Business As Name
NPI ?1013946250
Entity TypeOrganization
Enumeration Date ? Jul 1, 2006
Last Update Date ? Oct 15, 2012
Note:
NPI: National Provider Identifier issued to health care providers by Centers for Medicare and Medicaid Services (CMS).

specialty-icon Specialties & Licenses of Shopko Stores Operating Co Llc

SpecialtySpecializationLicenseLicense State
Durable Medical Equipment & Medical Supplies
Pharmacy
PharmacyCommunity/Retail Pharmacy

legacy-id-icon Legacy Provider IDs of Shopko Stores Operating Co Llc

Provider IdIssuer StateIssuer TypeIssuer
5695760216Medicare Nsc
1536690OtherNCPDP
0459230115Medicare Id-type Unspecified
200445250AIndianaMedicaid

official-icon Authorized Official of Shopko Stores Operating Co Llc

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/PositionEXECUTIVE VICE PRESIDENT & COO
Authorized Official Phone Number920-429-4297