Provider Information for 1912398736
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SHOPKO STORES OPERATING CO., LLC
Other Names:Doing Business As:SHOPKO PHARMACY 795Organization Subpart: NO
NPI: 1912398736
Last Updated: 2015-07-07
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Details
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NPI | 1912398736 | ||||||||||||||||
Enumeration Date | 2015-02-16 | ||||||||||||||||
NPI Type | NPI-2 Organization | ||||||||||||||||
Status | Active | ||||||||||||||||
Authorized Official Information | Name: LORIE NEUMANN Title: Dir 3d Party Contract & CA Phone: 9204294726 | ||||||||||||||||
Mailing Address | 1026 S CHALLIS ST SALMON, ID 83467-5441 United States Phone: 208-742-1285 | Fax:208-742-1283 | ||||||||||||||||
Primary Practice Address | 1026 S CHALLIS ST SALMON, ID 83467-5441 United States Phone: 208-742-1285 | Fax:208-742-1283 | ||||||||||||||||
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