Nicolet Pharmacy, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

757642 Issued in WI

Legal business name

NICOLET PHARMACY, INC.

Doing business as

Nicolet Pharmacy Inc-340B Pharmacy

Practice address

15481 Commercial Rd
Lakewood, WI 54138-9677

Phone

(715) 276-3646

Fax

(715) 276-9568

NPI assigned

Feb 14, 2012

Last updated

Feb 14, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gary DonaldsonNPI 1841473717

Title

President

Phone

(715) 276-3646

Specialties & licenses 1

Addresses

Other names 1

• Nicolet Pharmacy Inc-340B Pharmacy Doing business as

Tax ID family

Nicolet Pharmacy Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Nicolet Pharmacy Long Term Care

  • Long Term Care Pharmacy
  • Lakewood, WI
  • NPI 1063302990
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gary A Donaldson, RPH

  • Pharmacist
  • Lakewood, WI
  • NPI 1841473717
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1329177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329177600000",
    "number": "1114290707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15481 COMMERCIAL RD",
            "city": "LAKEWOOD",
            "state": "WI",
            "postal_code": "541389677",
            "telephone_number": "715-276-3646",
            "fax_number": "715-276-9568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15481 COMMERCIAL RD",
            "city": "LAKEWOOD",
            "state": "WI",
            "postal_code": "541389677",
            "telephone_number": "715-276-3646",
            "fax_number": "715-276-9568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICOLET PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-14",
        "last_updated": "2012-02-14",
        "status": "A",
        "authorized_official_last_name": "DONALDSON",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "715-276-3646"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WI",
            "license": "757642",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nicolet Pharmacy Inc-340B Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Derek Loch, RPH
• Jodi Marie Marsh, LPC
• Lori Lee Nelson, RDH
• Nicolet Pharmacy Inc (Nicolet Pharmacy)
• Nicolet Pharmacy Long Term Care
• Nobles Chiropractic Wellness Center, LLC
• Oconto Hospital & Medical Center Inc (Bellin Health Lakewood)
• Lance R. Orlinski, D.D.S.
• Orthopedic & Spine Therapy of Lakewood, SC
• Orthopedic & Spine Therapy of Lakewood, SC

• Community/Retail Pharmacy in Lakewood, WI
• Providers in Lakewood, WI by specialty
• Community/Retail Pharmacy in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.